ADVANCING STRATEGIES FORIDENTIFYING CLINICAL SOLUTIONS FOR
SARS-CoV-2
The COVID-19 emergency requires the urgent development of new strategies to protect the population, mainly those most at risk. Since March 2020, a dedicated team of researchers from the STI and Skin NTD Unit has worked to transfer their knowledge on epidemiology into clinical solutions for the Covid-19 pandemic. This work, still on-going, is done thanks to the contribution of citizens (channelled through the #YoMeCorono initiative), and of public and private institutions that are gathering forces to find a treatment for SARS-CoV-2.
Selected publications
In addition to the Test and Treat and the COnV-ert studies, aimed at identifying clinical solutions against SARS-CoV-2 (listed hereunder as “Therapeutics”), the Unit has performed analyses to advance knowledge in the fields of diagnostics, transmission, and risk factors.
a. Therapeutics
Ávila-Nieto, Carlos; Pedreño-Lopez, Núria; Mitjà, Oriol; et al.
Syphilis vaccine: challenges, controversies and opportunities Journal Article
In: Frontiers in Immunology, vol. 14, 2023.
@article{NIETO2023SUBCUT,
title = {Syphilis vaccine: challenges, controversies and opportunities},
author = {Carlos Ávila-Nieto and Núria Pedreño-Lopez and Oriol Mitjà and Bonaventura Clotet and Julà Blanco and Jorge Carrillo},
doi = {https://doi.org/10.3389/fimmu.2023.1126170},
year = {2023},
date = {2023-01-01},
journal = {Frontiers in Immunology},
volume = {14},
abstract = {Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.
Mitjà, Oriol; Suñer, Clara; Giacani, Lorenzo; et al.
Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100737, 2023, ISSN: 2666-7762.
@article{MITJA2023100737,
title = {Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis},
author = {Oriol Mitjà and Clara Suñer and Lorenzo Giacani and Martí Vall-Mayans and George-Sorin Tiplica and Jonathan D. C. Ross and Catriona S. Bradshaw},
doi = {https://doi.org/10.1016/j.lanepe.2023.100737},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100737},
abstract = {This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.
Gökengin, Deniz; Noori, Teymur; Alemany, Andrea; et al.
Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100738, 2023, ISSN: 2666-7762.
@article{GOKENGIN2023100738,
title = {Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe},
author = {Deniz Gökengin and Teymur Noori and Andrea Alemany and Carlo Bienkowski and Geoffroy Liegon and Ahmet Çağkan İnkaya and Jorge Carrillo and Georg Stary and Katja Knapp and Oriol Mitja and Jean-Michel Molina},
doi = {https://doi.org/10.1016/j.lanepe.2023.100738},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100738},
abstract = {The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
Mitjà, Oriol; Padovese, Valeska; Folch, Cinta; et al.
Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100742, 2023, ISSN: 2666-7762.
@article{MITJA2023100742,
title = {Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe},
author = {Oriol Mitjà and Valeska Padovese and Cinta Folch and Isotta Rossoni and Michael Marks and Miquel Angel Rodríguez Arias and Amalio Telenti and Angela Ciuffi and Karel Blondeel and Otilia Mårdh and Jordi Casabona},
doi = {https://doi.org/10.1016/j.lanepe.2023.100742},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100742},
abstract = {In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
Fernández-Naval, Candela; Arando, Maider; Espasa, Mateu; et al.
Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona Journal Article
In: Future Microbiology, vol. 16, no. 13, pp. 967-976, 2021.
@article{Fernandez2021,
title = {Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona},
author = {Candela Fernández-Naval and Maider Arando and Mateu Espasa and Andrés Antón and Miguel Fernández-Huerta and Aroa Silgado and Cristina Pinatar and Francesc Zarzuela and Juan José González-López and Judit Serra-Pladevall and Elena Sulleiro and Tomàs Pumarola and Martí Vall-Mayans and Juliana Esperalba},
doi = {https://doi.org/10.2217/fmb-2021-0037},
year = {2021},
date = {2021-01-01},
journal = {Future Microbiology},
volume = {16},
number = {13},
pages = {967-976},
abstract = {Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.
Haynes, Austin M.; Giacani, Lorenzo; Mayans, Marti Vall; et al.
Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study Journal Article
In: EBioMedicine, vol. 65, 2021, ISSN: 2352-3964.
@article{Haynes2021,
title = {Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study},
author = {Austin M. Haynes and Lorenzo Giacani and Marti Vall Mayans and Maria Ubals and Carles Nieto and Clara Pérez-Mañá and Llorenç Quintó and Emily Romeis and Oriol Mitjà},
doi = {10.1016/j.ebiom.2021.103281},
issn = {2352-3964},
year = {2021},
date = {2021-01-01},
journal = {EBioMedicine},
volume = {65},
publisher = {Elsevier},
abstract = {Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.
Hoyos-Mallecot, Yannick; Garcia, Jorge Nestor; Sulleiro, Elena; et al.
Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification Journal Article
In: Sexually Transmitted Infections, 2021, ISSN: 1368-4973.
@article{Hoyos-Mallecotsextrans-2020-054779,
title = {Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification},
author = {Yannick Hoyos-Mallecot and Jorge Nestor Garcia and Elena Sulleiro and Juliana Esperalba and Paula Salmeron and Francesc Zarzuela and Albert Blanco and Maider Arando and Vicente Descalzo and Luis Lopez and Martí Vall-Mayans and María Jesús Barberá and Judit Serra-Pladevall and Montserrat LLinas and Benito Almirante and Tomas Pumarola and Mateu Espasa},
doi = {10.1136/sextrans-2020-054779},
issn = {1368-4973},
year = {2021},
date = {2021-01-01},
journal = {Sexually Transmitted Infections},
publisher = {The Medical Society for the Study of Venereal Disease},
abstract = {Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.
Levine, Adam C; Fukuta, Yuriko; Huaman, Moises A; et al.
In: Clinical Infectious Diseases, vol. 76, no. 12, pp. 2077-2086, 2023, ISSN: 1058-4838.
@article{10.1093/cid/ciad088b,
title = {Coronavirus Disease 2019 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-Analysis of Individual Participant Data From 5 Randomized Trials},
author = {Levine, Adam C and Fukuta, Yuriko and Huaman, Moises A and Ou, Jiangda and Meisenberg, Barry R and Patel, Bela and Paxton, James H and Hanley, Daniel F and Rijnders, Bart J A and Gharbharan, Arvind and Rokx, Casper and Zwaginga, Jaap Jan and Alemany, Andrea and Mitjà, Oriol and Ouchi, Dan and Millat-Martinez, Pere and Durkalski-Mauldin, Valerie and Korley, Frederick K and Dumont, Larry J and Callaway, Clifton W and Libster, Romina and Marc, Gonzalo Perez and Wappner, Diego and Esteban, Ignacio and Polack, Fernando and Sullivan, David J},
doi = {10.1093/cid/ciad088},
issn = {1058-4838},
year = {2023},
date = {2023-01-01},
urldate = {2023-01-01},
journal = {Clinical Infectious Diseases},
volume = {76},
number = {12},
pages = {2077-2086},
abstract = {Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results.We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022.Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%–6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%–11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer.Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results.We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022.Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%–6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%–11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer.Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.
Alemany, A.; Perez-Zsolt, D.; Raïch-Regué, D.; et al.
Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial Journal Article
In: Journal of Dental Research, vol. 101, no. 12, pp. 1450-1456, 2022.
@article{doi:10.1177/00220345221102310b,
title = {Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial},
author = {A. Alemany and D. Perez-Zsolt and D. Raïch-Regué and J. Muñoz-Basagoiti and D. Ouchi and C. Laporte-Villar and B. Baro and N. Henríquez and N. Prat and M. Ochoa Gianinetto and M. Viaplana Gutiérrez and M. Garcia Sánchez-Paniagua and N. Larrosa Henríquez and J. Moreno Vicente and J. Ara and M. A. Rodriguez-Arias and J. Puig and I. Blanco and C. Casañ Lopez and Á. Hernández and A. E. Bordoy and C. Esteban Redondo and V. González Soler and M. Giménez and V. Blanc and R. León and J. Gispert and CPC-COVID GROUP and B. Clotet and N. Izquierdo-Useros and O. Mitjà},
doi = {10.1177/00220345221102310},
year = {2022},
date = {2022-01-01},
journal = {Journal of Dental Research},
volume = {101},
number = {12},
pages = {1450-1456},
abstract = {The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1–441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0–742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1–441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0–742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.
Alemany, Andrea; Millat-Martinez, Pere; Corbacho-Monné, Marc; et al.
In: The Lancet Respiratory Medicine, 2022, ISSN: 2213-2600.
@article{ref1c,
title = {High-titre methylene blue-treated convalescent plasma as an early treatment for outpatients with COVID-19: a randomised, placebo-controlled trial},
author = {Andrea Alemany and Pere Millat-Martinez and Marc Corbacho-Monné and Pierre Malchair and Dan Ouchi and Anna Ruiz-Comellas and Anna Ramírez-Morros and Joana Rodríguez Codina and Rosa Amado Simon and Sebastian Videla and Gèlia Costes and Mar Capdevila-Jáuregui and Pamela Torrano-Soler and Alba San José and Glòria Bonet Papell and Jordi Puig and Aurema Otero and Jose Carlos Ruibal Suarez and Alvaro Zarauza Pellejero and Ferran Llopis Roca and Orlando Rodriguez Cortez and Vanesa Garcia Garcia and Josep Vidal-Alaball and Anna Millan and Enric Contreras and Joan-Ramon Grifols and Àgueda Ancochea and Ivan Galvan-Femenia and Francini Piccolo Ferreira and Mireia Bonet and Jordi Cantoni and Núria Prat and Jordi Ara and Anna Forcada Arcarons and Magí Farré and Edwards Pradenas and Julià Blanco and Miquel Àngel Rodriguez-Arias and Gema Fernández Rivas and Michael Marks and Quique Bassat and Ignacio Blanco and Bàrbara Baro and Bonaventura Clotet and Oriol Mitjà and Susana Ferrer and Mireia Gallardo and Maria Ubals and Camila González-Beiras and Martí Vall-Mayans and Clara Suñer and Clàudia Laporte-Villar and Aroa Nieto and Xavier Comas-Leon and Zahida Jiménez and Ferran Ramírez-Viaplana and Maria Delgado-Capel and Beatriz Díez Sánchez and Maria Pons Barber and Cristian Gonzalez Ruiz and Laura Navarrete Gonzalez and David González García and Ainhoa Vivero Larraza and Victor Carceles Peiró and Clàudia Roquer López and Neus Robert and Carles Palet and Carlota Gudiol and Pablo Casares Gonzalez and Gemma Arcos Vila and Begoña Flores Aguilera and Graciela Rodríguez-Sevilla and Macarena Dastis Arias and Judit Roca Font and Katherine M. Carrasco Matos and Glòria Saüch Valmaña and Carla Vidal Obradors and Silvia Tarres García and Margarida Curriu Sabatès and Raquel Nieto Rodríguez and Rosa Línio and Míriam Fornos and Natàlia Casamitjana and Eva Alonso and Núria Martínez and Laura Analía Maglio and Laura Comellas Fernandez and Nadia Garcia and Luis Hernández and Maria Isabel González and Anna Bravo and Yolanda García and Silvia Sauleda Oliveras and Tatiana Vertiz and Sergio Benavent and Andrea Sofia Bianco and Joaquim Verdaguer and Ney Nicanor Briones Zambrano and Maria Viozquez Meya and Águeda Hernández and Cristina Casaña Lopez and Antoni E. Bordoy and Victoria González Soler and Montserrat Giménez and Alexa París and Silvia Marfil and Benjamin Trinité and Eulàlia Grau},
doi = {10.1016/S2213-2600(21)00545-2},
issn = {2213-2600},
year = {2022},
date = {2022-01-01},
journal = {The Lancet Respiratory Medicine},
publisher = {Elsevier},
abstract = {Convalescent plasma has been proposed as an early treatment to interrupt the progression of early COVID-19 to severe disease, but there is little definitive evidence. We aimed to assess whether early treatment with convalescent plasma reduces the risk of hospitalisation and reduces SARS-CoV-2 viral load among outpatients with COVID-19.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Convalescent plasma has been proposed as an early treatment to interrupt the progression of early COVID-19 to severe disease, but there is little definitive evidence. We aimed to assess whether early treatment with convalescent plasma reduces the risk of hospitalisation and reduces SARS-CoV-2 viral load among outpatients with COVID-19.
Mitjà, Oriol; Corbacho-Monné, Marc; Ubals, Maria; et al.
A Cluster-Randomized Trial of Hydroxy-chloro-quine for Prevention of Covid-19 Journal Article
In: New England Journal of Medicine, vol. 384, no. 5, pp. 417-427, 2021.
@article{NEJMoa2021801b,
title = {A Cluster-Randomized Trial of Hydroxy-chloro-quine for Prevention of Covid-19},
author = {Oriol Mitjà and Marc Corbacho-Monné and Maria Ubals and Andrea Alemany and Clara Suñer and Cristian Tebé and Aurelio Tobias and Judith Peñafiel and Ester Ballana and Carla A. Pérez and Pol Admella and Núria Riera-Martí and Pep Laporte and Jordi Mitjà and Mireia Clua and Laia Bertran and Maria Sarquella and Sergi Gavilán and Jordi Ara and Josep M. Argimon and Gabriel Cuatrecasas and Paz Cañadas and Aleix Elizalde-Torrent and Robert Fabregat and Magí Farré and Anna Forcada and Gemma Flores-Mateo and Cristina López and Esteve Muntada and Núria Nadal and Silvia Narejos and Aroa Nieto and Nuria Prat and Jordi Puig and Carles Quiñones and Ferran Ramírez-Viaplana and Juliana Reyes-Urueña and Eva Riveira-Muñoz and Lidia Ruiz and Sergi Sanz and Alexis Sentís and Alba Sierra and César Velasco and Rosa M. Vivanco-Hidalgo and Juani Zamora and Jordi Casabona and Martí Vall-Mayans and Camila González-Beiras and Bonaventura Clotet},
doi = {10.1056/NEJMoa2021801},
year = {2021},
date = {2021-01-01},
journal = {New England Journal of Medicine},
volume = {384},
number = {5},
pages = {417-427},
abstract = {Current strategies for preventing severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection are limited to nonpharmacologic interventions. Hydroxychloroquine has been proposed as a postexposure therapy to prevent coronavirus
disease 2019 (Covid-19), but definitive evidence is lacking. (Funded by the crowdfunding campaign YoMeCorono and others;
BCN-PEP-CoV2 ClinicalTrials.gov number, NCT04304053.)},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Current strategies for preventing severe acute respiratory syndrome coronavirus 2
(SARS-CoV-2) infection are limited to nonpharmacologic interventions. Hydroxychloroquine has been proposed as a postexposure therapy to prevent coronavirus
disease 2019 (Covid-19), but definitive evidence is lacking. (Funded by the crowdfunding campaign YoMeCorono and others;
BCN-PEP-CoV2 ClinicalTrials.gov number, NCT04304053.)
(SARS-CoV-2) infection are limited to nonpharmacologic interventions. Hydroxychloroquine has been proposed as a postexposure therapy to prevent coronavirus
disease 2019 (Covid-19), but definitive evidence is lacking. (Funded by the crowdfunding campaign YoMeCorono and others;
BCN-PEP-CoV2 ClinicalTrials.gov number, NCT04304053.)
Mitjà, Oriol; Corbacho-Monné, Marc; Ubals, Maria; et al.
Hydroxychloroquine for Early Treatment of Adults With Mild Coronavirus Disease 2019: A Randomized, Controlled Trial Journal Article
In: Clinical Infectious Diseases, vol. 73, no. 11, pp. e4073-e4081, 2020, ISSN: 1058-4838.
@article{10.1093/cid/ciaa1009b,
title = {Hydroxychloroquine for Early Treatment of Adults With Mild Coronavirus Disease 2019: A Randomized, Controlled Trial},
author = {Oriol Mitjà and Marc Corbacho-Monné and Maria Ubals and Cristian Tebé and Judith Peñafiel and Aurelio Tobias and Ester Ballana and Andrea Alemany and Núria Riera-Martí and Carla A Pérez and Clara Suñer and Pep Laporte and Pol Admella and Jordi Mitjà and Mireia Clua and Laia Bertran and Maria Sarquella and Sergi Gavilán and Jordi Ara and Josep M Argimon and Jordi Casabona and Gabriel Cuatrecasas and Paz Cañadas and Aleix Elizalde-Torrent and Robert Fabregat and Magí Farré and Anna Forcada and Gemma Flores-Mateo and Esteve Muntada and Núria Nadal and Silvia Narejos and Aroa Nieto and Nuria Prat and Jordi Puig and Carles Quiñones and Juliana Reyes-Ureña and Ferran Ramírez-Viaplana and Lidia Ruiz and Eva Riveira-Muñoz and Alba Sierra and César Velasco and Rosa Maria Vivanco-Hidalgo and Alexis Sentís and Camila G-Beiras and Bonaventura Clotet and Barcelona Post-exposure Prophylaxis for Coronavirus type-2 (BCN PEP-CoV-2) Research Group Martí Vall-Mayans},
doi = {10.1093/cid/ciaa1009},
issn = {1058-4838},
year = {2020},
date = {2020-01-01},
journal = {Clinical Infectious Diseases},
volume = {73},
number = {11},
pages = {e4073-e4081},
abstract = {No effective treatments for coronavirus disease 2019 (COVID-19) exist. We aimed to determine whether early treatment with hydroxychloroquine (HCQ) would be efficacious for outpatients with COVID-19.Multicenter open-label, randomized, controlled trial conducted in Catalonia, Spain, between 17 March and 26 May 2020. Patients recently diagnosed with <5-day of symptom onset were assigned to receive HCQ (800 mg on day 1 followed by 400 mg once daily for 6 days) or usual care. Outcomes were reduction of viral load in nasopharyngeal swabs up to 7 days after treatment start, disease progression up to 28 days, and time to complete resolution of symptoms. Adverse events were assessed up to 28 days.A total of 293 patients were eligible for intention-to-treat analysis: 157 in the control arm and 136 in the intervention arm. The mean age was 41.6 years (SD, 12.6), mean viral load at baseline was 7.90 log10 copies/mL (SD, 1.82), and median time from symptom onset to randomization was 3 days. No differences were found in the mean reduction of viral load at day 3 (−1.41 vs −1.41 log10 copies/mL in the control and intervention arm, respectively) or at day 7 (−3.37 vs −3.44). Treatment did not reduce risk of hospitalization (7.1% control vs 5.9% intervention) nor shorten the time to complete resolution of symptoms (12 days, control vs 10 days, intervention). No relevant adverse events were reported.In patients with mild COVID-19, no benefit was observed with HCQ beyond the usual care.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
No effective treatments for coronavirus disease 2019 (COVID-19) exist. We aimed to determine whether early treatment with hydroxychloroquine (HCQ) would be efficacious for outpatients with COVID-19.Multicenter open-label, randomized, controlled trial conducted in Catalonia, Spain, between 17 March and 26 May 2020. Patients recently diagnosed with <5-day of symptom onset were assigned to receive HCQ (800 mg on day 1 followed by 400 mg once daily for 6 days) or usual care. Outcomes were reduction of viral load in nasopharyngeal swabs up to 7 days after treatment start, disease progression up to 28 days, and time to complete resolution of symptoms. Adverse events were assessed up to 28 days.A total of 293 patients were eligible for intention-to-treat analysis: 157 in the control arm and 136 in the intervention arm. The mean age was 41.6 years (SD, 12.6), mean viral load at baseline was 7.90 log10 copies/mL (SD, 1.82), and median time from symptom onset to randomization was 3 days. No differences were found in the mean reduction of viral load at day 3 (−1.41 vs −1.41 log10 copies/mL in the control and intervention arm, respectively) or at day 7 (−3.37 vs −3.44). Treatment did not reduce risk of hospitalization (7.1% control vs 5.9% intervention) nor shorten the time to complete resolution of symptoms (12 days, control vs 10 days, intervention). No relevant adverse events were reported.In patients with mild COVID-19, no benefit was observed with HCQ beyond the usual care.
Hydroxychloroquine for treatment of non-hospitalized adults wih COVID-19: A meta-analysis of individual participant data of randomized trial Journal Article
In: 0000.
@article{Mitja2023-wfb,
title = {Hydroxychloroquine for treatment of non-hospitalized adults wih
COVID-19: A meta-analysis of individual participant data of
randomized trial},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
b. Diagnostics
Ávila-Nieto, Carlos; Pedreño-Lopez, Núria; Mitjà, Oriol; et al.
Syphilis vaccine: challenges, controversies and opportunities Journal Article
In: Frontiers in Immunology, vol. 14, 2023.
@article{NIETO2023SUBCUT,
title = {Syphilis vaccine: challenges, controversies and opportunities},
author = {Carlos Ávila-Nieto and Núria Pedreño-Lopez and Oriol Mitjà and Bonaventura Clotet and Julà Blanco and Jorge Carrillo},
doi = {https://doi.org/10.3389/fimmu.2023.1126170},
year = {2023},
date = {2023-01-01},
journal = {Frontiers in Immunology},
volume = {14},
abstract = {Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.
Mitjà, Oriol; Suñer, Clara; Giacani, Lorenzo; et al.
Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100737, 2023, ISSN: 2666-7762.
@article{MITJA2023100737,
title = {Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis},
author = {Oriol Mitjà and Clara Suñer and Lorenzo Giacani and Martí Vall-Mayans and George-Sorin Tiplica and Jonathan D. C. Ross and Catriona S. Bradshaw},
doi = {https://doi.org/10.1016/j.lanepe.2023.100737},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100737},
abstract = {This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.
Gökengin, Deniz; Noori, Teymur; Alemany, Andrea; et al.
Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100738, 2023, ISSN: 2666-7762.
@article{GOKENGIN2023100738,
title = {Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe},
author = {Deniz Gökengin and Teymur Noori and Andrea Alemany and Carlo Bienkowski and Geoffroy Liegon and Ahmet Çağkan İnkaya and Jorge Carrillo and Georg Stary and Katja Knapp and Oriol Mitja and Jean-Michel Molina},
doi = {https://doi.org/10.1016/j.lanepe.2023.100738},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100738},
abstract = {The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
Mitjà, Oriol; Padovese, Valeska; Folch, Cinta; et al.
Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100742, 2023, ISSN: 2666-7762.
@article{MITJA2023100742,
title = {Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe},
author = {Oriol Mitjà and Valeska Padovese and Cinta Folch and Isotta Rossoni and Michael Marks and Miquel Angel Rodríguez Arias and Amalio Telenti and Angela Ciuffi and Karel Blondeel and Otilia Mårdh and Jordi Casabona},
doi = {https://doi.org/10.1016/j.lanepe.2023.100742},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100742},
abstract = {In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
Fernández-Naval, Candela; Arando, Maider; Espasa, Mateu; et al.
Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona Journal Article
In: Future Microbiology, vol. 16, no. 13, pp. 967-976, 2021.
@article{Fernandez2021,
title = {Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona},
author = {Candela Fernández-Naval and Maider Arando and Mateu Espasa and Andrés Antón and Miguel Fernández-Huerta and Aroa Silgado and Cristina Pinatar and Francesc Zarzuela and Juan José González-López and Judit Serra-Pladevall and Elena Sulleiro and Tomàs Pumarola and Martí Vall-Mayans and Juliana Esperalba},
doi = {https://doi.org/10.2217/fmb-2021-0037},
year = {2021},
date = {2021-01-01},
journal = {Future Microbiology},
volume = {16},
number = {13},
pages = {967-976},
abstract = {Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.
Haynes, Austin M.; Giacani, Lorenzo; Mayans, Marti Vall; et al.
Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study Journal Article
In: EBioMedicine, vol. 65, 2021, ISSN: 2352-3964.
@article{Haynes2021,
title = {Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study},
author = {Austin M. Haynes and Lorenzo Giacani and Marti Vall Mayans and Maria Ubals and Carles Nieto and Clara Pérez-Mañá and Llorenç Quintó and Emily Romeis and Oriol Mitjà},
doi = {10.1016/j.ebiom.2021.103281},
issn = {2352-3964},
year = {2021},
date = {2021-01-01},
journal = {EBioMedicine},
volume = {65},
publisher = {Elsevier},
abstract = {Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.
Hoyos-Mallecot, Yannick; Garcia, Jorge Nestor; Sulleiro, Elena; et al.
Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification Journal Article
In: Sexually Transmitted Infections, 2021, ISSN: 1368-4973.
@article{Hoyos-Mallecotsextrans-2020-054779,
title = {Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification},
author = {Yannick Hoyos-Mallecot and Jorge Nestor Garcia and Elena Sulleiro and Juliana Esperalba and Paula Salmeron and Francesc Zarzuela and Albert Blanco and Maider Arando and Vicente Descalzo and Luis Lopez and Martí Vall-Mayans and María Jesús Barberá and Judit Serra-Pladevall and Montserrat LLinas and Benito Almirante and Tomas Pumarola and Mateu Espasa},
doi = {10.1136/sextrans-2020-054779},
issn = {1368-4973},
year = {2021},
date = {2021-01-01},
journal = {Sexually Transmitted Infections},
publisher = {The Medical Society for the Study of Venereal Disease},
abstract = {Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.
Levine, Adam C; Fukuta, Yuriko; Huaman, Moises A; et al.
In: Clinical Infectious Diseases, vol. 76, no. 12, pp. 2077-2086, 2023, ISSN: 1058-4838.
@article{10.1093/cid/ciad088,
title = {Coronavirus Disease 2019 Convalescent Plasma Outpatient Therapy to Prevent Outpatient Hospitalization: A Meta-Analysis of Individual Participant Data From 5 Randomized Trials},
author = {Adam C Levine and Yuriko Fukuta and Moises A Huaman and Jiangda Ou and Barry R Meisenberg and Bela Patel and James H Paxton and Daniel F Hanley and Bart J A Rijnders and Arvind Gharbharan and Casper Rokx and Jaap Jan Zwaginga and Andrea Alemany and Oriol Mitjà and Dan Ouchi and Pere Millat-Martinez and Valerie Durkalski-Mauldin and Frederick K Korley and Larry J Dumont and Clifton W Callaway and Romina Libster and Gonzalo Perez Marc and Diego Wappner and Ignacio Esteban and Fernando Polack and David J Sullivan},
doi = {10.1093/cid/ciad088},
issn = {1058-4838},
year = {2023},
date = {2023-01-01},
journal = {Clinical Infectious Diseases},
volume = {76},
number = {12},
pages = {2077-2086},
abstract = {Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results.We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022.Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%–6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%–11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer.Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Outpatient monoclonal antibodies are no longer effective and antiviral treatments for coronavirus disease 2019 (COVID-19) disease remain largely unavailable in many countries worldwide. Although treatment with COVID-19 convalescent plasma (CCP) is promising, clinical trials among outpatients have shown mixed results.We conducted an individual participant data meta-analysis from outpatient trials to assess the overall risk reduction for all-cause hospitalizations by day 28 in transfused participants. Relevant trials were identified by searching Medline, Embase, medRxiv, World Health Organization COVID-19 Research Database, Cochrane Library, and Web of Science from January 2020 to September 2022.Five included studies from 4 countries enrolled and transfused 2620 adult patients. Comorbidities were present in 1795 (69%). The virus neutralizing antibody dilutional titer levels ranged from 8 to 14 580 in diverse assays. One hundred sixty of 1315 (12.2%) control patients were hospitalized, versus 111 of 1305 (8.5%) CCP-treated patients, yielding a 3.7% (95% confidence interval [CI], 1.3%–6.0%; P = .001) absolute risk reduction and 30.1% relative risk reduction for all-cause hospitalization. The hospitalization reduction was greatest in those with both early transfusion and high titer with a 7.6% absolute risk reduction (95% CI, 4.0%–11.1%; P = .0001) accompanied by at 51.4% relative risk reduction. No significant reduction in hospitalization was seen with treatment >5 days after symptom onset or in those receiving CCP with antibody titers below the median titer.Among outpatients with COVID-19, treatment with CCP reduced the rate of all-cause hospitalization and may be most effective when given within 5 days of symptom onset and when antibody titer is higher.
Alemany, A.; Perez-Zsolt, D.; Raïch-Regué, D.; et al.
Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial Journal Article
In: Journal of Dental Research, vol. 101, no. 12, pp. 1450-1456, 2022.
@article{doi:10.1177/00220345221102310,
title = {Cetylpyridinium Chloride Mouthwash to Reduce Shedding of Infectious SARS-CoV-2: A Double-Blind Randomized Clinical Trial},
author = {A. Alemany and D. Perez-Zsolt and D. Raïch-Regué and J. Muñoz-Basagoiti and D. Ouchi and C. Laporte-Villar and B. Baro and N. Henríquez and N. Prat and M. Ochoa Gianinetto and M. Viaplana Gutiérrez and M. Garcia Sánchez-Paniagua and N. Larrosa Henríquez and J. Moreno Vicente and J. Ara and M. A. Rodriguez-Arias and J. Puig and I. Blanco and C. Casañ Lopez and Á. Hernández and A. E. Bordoy and C. Esteban Redondo and V. González Soler and M. Giménez and V. Blanc and R. León and J. Gispert and CPC-COVID GROUP and B. Clotet and N. Izquierdo-Useros and O. Mitjà},
doi = {10.1177/00220345221102310},
year = {2022},
date = {2022-01-01},
journal = {Journal of Dental Research},
volume = {101},
number = {12},
pages = {1450-1456},
abstract = {The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1–441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0–742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via respiratory fluids and droplets suggests that mouthwashes containing substances with virucidal activity can help reduce viral spread. We conducted a multicenter, double-blind, placebo-controlled, randomized trial to assess the virucidal activity of cetylpyridinium chloride (CPC) mouthwashes. Outpatients who tested positive for SARS-CoV-2 infection with or without symptoms were randomized to perform washes and gargles for 1 min with 15 mL of either colored distilled water or 0.07% CPC (Vitis CPC Protect) mouthwash. The study outcomes were the SARS-CoV-2 log10 viral RNA load and the nucleocapsid protein levels, both in saliva at 1 and 3 h after the intervention. In total, 118 patients were enrolled and randomized (mean [SD], age 46 [14] y). Thirteen of 118 participants (11%) did not complete follow-up or had insufficient sample volume for testing and were excluded from the analysis. The assessment of the viral load showed no significant differences between groups at any of the investigated points. However, the levels of SARS-CoV-2 nucleocapsid protein of lysed viruses were significantly higher in the CPC group compared with the control group at 1 h (adjusted difference 269.3 pg/mL; 95% confidence interval [CI], 97.1–441.5) and at 3 h postintervention (561.1 pg/mL; 95% CI, 380.0–742.2). In nonhospitalized patients with asymptomatic or mild symptomatic SARS-CoV-2 infection, a 0.07% CPC mouthwash, compared to placebo, was associated with a significant increase of nucleocapsid protein levels in saliva, indicating enhanced disruption of viral particles.
Alemany, Andrea; Millat-Martinez, Pere; Ouchi, Dan; et al.
Self-collected mid-nasal swabs and saliva specimens, compared with nasopharyngeal swabs, for SARS-CoV-2 detection in mild COVID-19 patients Journal Article
In: Journal of Infection, vol. 83, no. 6, pp. 709-737, 2021, ISSN: 0163-4453.
@article{Alemany2021_self,
title = {Self-collected mid-nasal swabs and saliva specimens, compared with nasopharyngeal swabs, for SARS-CoV-2 detection in mild COVID-19 patients},
author = {Andrea Alemany and Pere Millat-Martinez and Dan Ouchi and Marc Corbacho-Monné and Antoni E. Bordoy and Cristina Esteban and Águeda Hernández and Cristina Casañ and Victoria Gonzalez and Gèlia Costes and Mar Capdevila-Jáuregui and Pamela Torrano-Soler and Alba San José and Jordi Ara and Núria Prat and Bonaventura Clotet and Quique Bassat and Montserrat Gimenez and Ignacio Blanco and Bàrbara Baro and Oriol Mitjà},
doi = {10.1016/j.jinf.2021.09.012},
issn = {0163-4453},
year = {2021},
date = {2021-12-01},
journal = {Journal of Infection},
volume = {83},
number = {6},
pages = {709-737},
publisher = {Elsevier},
abstract = {Self-collected nasal and saliva samples can be used for SARS-CoV-2 screening.?Self-collected nasal and saliva specimens had a 99% and 90% sensitivity, respectively.?Nasopharyngeal swab viral loads correlate better with nasal than saliva.?Viral load correlations are poorer at day 7, when lower viral loads are observed.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Self-collected nasal and saliva samples can be used for SARS-CoV-2 screening.?Self-collected nasal and saliva specimens had a 99% and 90% sensitivity, respectively.?Nasopharyngeal swab viral loads correlate better with nasal than saliva.?Viral load correlations are poorer at day 7, when lower viral loads are observed.
Alemany, Andrea; Baró, Bàrbara; Ouchi, Dan; et al.
Analytical and clinical performance of the panbio COVID-19 antigen-detecting rapid diagnostic test Journal Article
In: Journal of Infection, vol. 82, no. 5, pp. 186-230, 2021, ISSN: 0163-4453.
@article{Alemany2021,
title = {Analytical and clinical performance of the panbio COVID-19 antigen-detecting rapid diagnostic test},
author = {Andrea Alemany and Bàrbara Baró and Dan Ouchi and Pau Rodó and Maria Ubals and Marc Corbacho-Monné and Júlia Vergara-Alert and Jordi Rodon and Joaquim Segalés and Cristina Esteban and Gema Fernández and Lidia Ruiz and Quique Bassat and Bonaventura Clotet and Jordi Ara and Martí Vall-Mayans and Camila G-Beiras and Ignacio Blanco and Oriol Mitjà},
doi = {10.1016/j.jinf.2020.12.033},
issn = {0163-4453},
year = {2021},
date = {2021-05-01},
journal = {Journal of Infection},
volume = {82},
number = {5},
pages = {186-230},
publisher = {Elsevier},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
c. Transmission
Ávila-Nieto, Carlos; Pedreño-Lopez, Núria; Mitjà, Oriol; et al.
Syphilis vaccine: challenges, controversies and opportunities Journal Article
In: Frontiers in Immunology, vol. 14, 2023.
@article{NIETO2023SUBCUT,
title = {Syphilis vaccine: challenges, controversies and opportunities},
author = {Carlos Ávila-Nieto and Núria Pedreño-Lopez and Oriol Mitjà and Bonaventura Clotet and Julà Blanco and Jorge Carrillo},
doi = {https://doi.org/10.3389/fimmu.2023.1126170},
year = {2023},
date = {2023-01-01},
journal = {Frontiers in Immunology},
volume = {14},
abstract = {Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.
Mitjà, Oriol; Suñer, Clara; Giacani, Lorenzo; et al.
Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100737, 2023, ISSN: 2666-7762.
@article{MITJA2023100737,
title = {Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis},
author = {Oriol Mitjà and Clara Suñer and Lorenzo Giacani and Martí Vall-Mayans and George-Sorin Tiplica and Jonathan D. C. Ross and Catriona S. Bradshaw},
doi = {https://doi.org/10.1016/j.lanepe.2023.100737},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100737},
abstract = {This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.
Gökengin, Deniz; Noori, Teymur; Alemany, Andrea; et al.
Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100738, 2023, ISSN: 2666-7762.
@article{GOKENGIN2023100738,
title = {Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe},
author = {Deniz Gökengin and Teymur Noori and Andrea Alemany and Carlo Bienkowski and Geoffroy Liegon and Ahmet Çağkan İnkaya and Jorge Carrillo and Georg Stary and Katja Knapp and Oriol Mitja and Jean-Michel Molina},
doi = {https://doi.org/10.1016/j.lanepe.2023.100738},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100738},
abstract = {The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
Mitjà, Oriol; Padovese, Valeska; Folch, Cinta; et al.
Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100742, 2023, ISSN: 2666-7762.
@article{MITJA2023100742,
title = {Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe},
author = {Oriol Mitjà and Valeska Padovese and Cinta Folch and Isotta Rossoni and Michael Marks and Miquel Angel Rodríguez Arias and Amalio Telenti and Angela Ciuffi and Karel Blondeel and Otilia Mårdh and Jordi Casabona},
doi = {https://doi.org/10.1016/j.lanepe.2023.100742},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100742},
abstract = {In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
Fernández-Naval, Candela; Arando, Maider; Espasa, Mateu; et al.
Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona Journal Article
In: Future Microbiology, vol. 16, no. 13, pp. 967-976, 2021.
@article{Fernandez2021,
title = {Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona},
author = {Candela Fernández-Naval and Maider Arando and Mateu Espasa and Andrés Antón and Miguel Fernández-Huerta and Aroa Silgado and Cristina Pinatar and Francesc Zarzuela and Juan José González-López and Judit Serra-Pladevall and Elena Sulleiro and Tomàs Pumarola and Martí Vall-Mayans and Juliana Esperalba},
doi = {https://doi.org/10.2217/fmb-2021-0037},
year = {2021},
date = {2021-01-01},
journal = {Future Microbiology},
volume = {16},
number = {13},
pages = {967-976},
abstract = {Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.
Haynes, Austin M.; Giacani, Lorenzo; Mayans, Marti Vall; et al.
Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study Journal Article
In: EBioMedicine, vol. 65, 2021, ISSN: 2352-3964.
@article{Haynes2021,
title = {Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study},
author = {Austin M. Haynes and Lorenzo Giacani and Marti Vall Mayans and Maria Ubals and Carles Nieto and Clara Pérez-Mañá and Llorenç Quintó and Emily Romeis and Oriol Mitjà},
doi = {10.1016/j.ebiom.2021.103281},
issn = {2352-3964},
year = {2021},
date = {2021-01-01},
journal = {EBioMedicine},
volume = {65},
publisher = {Elsevier},
abstract = {Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.
Hoyos-Mallecot, Yannick; Garcia, Jorge Nestor; Sulleiro, Elena; et al.
Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification Journal Article
In: Sexually Transmitted Infections, 2021, ISSN: 1368-4973.
@article{Hoyos-Mallecotsextrans-2020-054779,
title = {Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification},
author = {Yannick Hoyos-Mallecot and Jorge Nestor Garcia and Elena Sulleiro and Juliana Esperalba and Paula Salmeron and Francesc Zarzuela and Albert Blanco and Maider Arando and Vicente Descalzo and Luis Lopez and Martí Vall-Mayans and María Jesús Barberá and Judit Serra-Pladevall and Montserrat LLinas and Benito Almirante and Tomas Pumarola and Mateu Espasa},
doi = {10.1136/sextrans-2020-054779},
issn = {1368-4973},
year = {2021},
date = {2021-01-01},
journal = {Sexually Transmitted Infections},
publisher = {The Medical Society for the Study of Venereal Disease},
abstract = {Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.
Suñer, Clara; Coma, Ermengol; Ouchi, Dan; et al.
In: The Lancet Regional Health – Europe, vol. 15, 2022, ISSN: 2666-7762.
@article{Suñer2022,
title = {Association between two mass-gathering outdoor events and incidence of SARS-CoV-2 infections during the fifth wave of COVID-19 in north-east Spain: A population-based control-matched analysis},
author = {Clara Suñer and Ermengol Coma and Dan Ouchi and Eduardo Hermosilla and Bàrbara Baro and Miquel Àngel Rodríguez-Arias and Jordi Puig and Bonaventura Clotet and Manuel Medina and Oriol Mitjà},
doi = {10.1016/j.lanepe.2022.100337},
issn = {2666-7762},
year = {2022},
date = {2022-04-01},
journal = {The Lancet Regional Health – Europe},
volume = {15},
publisher = {Elsevier},
abstract = {Many countries have resumed mass-gathering events like music festivals, despite the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. In this study, we aimed to assess the effect of two mass-gathering outdoor events, held during a peak of SARS-CoV-2 transmission, on COVID-19 incidence.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Many countries have resumed mass-gathering events like music festivals, despite the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spreading. In this study, we aimed to assess the effect of two mass-gathering outdoor events, held during a peak of SARS-CoV-2 transmission, on COVID-19 incidence.
Marks, Michael; Millat-Martinez, Pere; Ouchi, Dan; et al.
Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study Journal Article
In: The Lancet Infectious Diseases, vol. 21, no. 5, pp. 629-636, 2021, ISSN: 1473-3099.
@article{Marks2021,
title = {Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study},
author = {Michael Marks and Pere Millat-Martinez and Dan Ouchi and Chrissy h. Roberts and Andrea Alemany and Marc Corbacho-Monné and Maria Ubals and Aurelio Tobias and Cristian Tebé and Ester Ballana and Quique Bassat and Bàrbara Baro and Martí Vall-Mayans and Camila G-Beiras and Nuria Prat and Jordi Ara and Bonaventura Clotet and Oriol Mitjà},
doi = {10.1016/S1473-3099(20)30985-3},
issn = {1473-3099},
year = {2021},
date = {2021-01-01},
journal = {The Lancet Infectious Diseases},
volume = {21},
number = {5},
pages = {629-636},
publisher = {Elsevier},
abstract = {Scarce data are available on what variables affect the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the development of symptomatic COVID-19, and, particularly, the relationship with viral load. We aimed to analyse data from linked index cases of COVID-19 and their contacts to explore factors associated with transmission of SARS-CoV-2.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Scarce data are available on what variables affect the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the development of symptomatic COVID-19, and, particularly, the relationship with viral load. We aimed to analyse data from linked index cases of COVID-19 and their contacts to explore factors associated with transmission of SARS-CoV-2.
c. Risk factors
Ávila-Nieto, Carlos; Pedreño-Lopez, Núria; Mitjà, Oriol; et al.
Syphilis vaccine: challenges, controversies and opportunities Journal Article
In: Frontiers in Immunology, vol. 14, 2023.
@article{NIETO2023SUBCUT,
title = {Syphilis vaccine: challenges, controversies and opportunities},
author = {Carlos Ávila-Nieto and Núria Pedreño-Lopez and Oriol Mitjà and Bonaventura Clotet and Julà Blanco and Jorge Carrillo},
doi = {https://doi.org/10.3389/fimmu.2023.1126170},
year = {2023},
date = {2023-01-01},
journal = {Frontiers in Immunology},
volume = {14},
abstract = {Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Syphilis is a sexually or vertically (mother to fetus) transmitted disease caused by the infection of Treponema pallidum subspecie pallidum (TPA). The incidence of syphilis has increased over the past years despite the fact that this bacterium is an obligate human pathogen, the infection route is well known, and the disease can be successfully treated with penicillin. As complementary measures to preventive campaigns and early treatment of infected individuals, development of a syphilis vaccine may be crucial for controlling disease spread and/or severity, particularly in countries where the effectiveness of the aforementioned measures is limited. In the last century, several vaccine prototypes have been tested in preclinical studies, mainly in rabbits. While none of them provided protection against infection, some prototypes prevented bacteria from disseminating to distal organs, attenuated lesion development, and accelerated their healing. In spite of these promising results, there is still some controversy regarding the identification of vaccine candidates and the characteristics of a syphilis-protective immune response. In this review, we describe what is known about TPA immune response, and the main mechanisms used by this pathogen to evade it. Moreover, we emphasize the importance of integrating this knowledge, in conjunction with the characterization of outer membrane proteins (OMPs), to expedite the development of a syphilis vaccine that can protect against TPA infection.
Mitjà, Oriol; Suñer, Clara; Giacani, Lorenzo; et al.
Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100737, 2023, ISSN: 2666-7762.
@article{MITJA2023100737,
title = {Treatment of bacterial sexually transmitted infections in Europe: gonorrhoea, Mycoplasma genitalium, and syphilis},
author = {Oriol Mitjà and Clara Suñer and Lorenzo Giacani and Martí Vall-Mayans and George-Sorin Tiplica and Jonathan D. C. Ross and Catriona S. Bradshaw},
doi = {https://doi.org/10.1016/j.lanepe.2023.100737},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100737},
abstract = {This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
This review explores the therapeutic challenges of sexually transmitted infections (STI) in Europe, which include increasing antimicrobial resistance and limited progress in drug discovery. We primarily focus on gonorrhoea, Mycoplasma genitalium, and syphilis infections. For gonorrhoea with escalating resistance rates we explore the possibility of combining ceftriaxone with another antibiotic or using alternative antibiotics to mitigate resistance emergence, and we provide insights on the ongoing evaluation of new antimicrobials, like gepotidacin and zoliflodacin. In the case of M. genitalium, which exhibits high resistance rates to first and second-line treatments, we emphasize the importance of resistance-guided therapy in regions with elevated resistance levels, and highlight the limited alternative options, such as pristinamycin and minocycline. Furthermore, we address the challenges posed by syphilis, where the primary treatment consists of penicillin or doxycycline, with challenges arising in neurosyphilis, allergy, pregnancy, and supply shortages and discuss the ongoing evaluation of alternative antimicrobials (e.g., ceftriaxone, cefixime, linezolid). Our findings identify priority actions and provide concrete solutions for long-term effective management of STIs and antimicrobial resistance mitigation.
Gökengin, Deniz; Noori, Teymur; Alemany, Andrea; et al.
Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100738, 2023, ISSN: 2666-7762.
@article{GOKENGIN2023100738,
title = {Prevention strategies for sexually transmitted infections, HIV, and viral hepatitis in Europe},
author = {Deniz Gökengin and Teymur Noori and Andrea Alemany and Carlo Bienkowski and Geoffroy Liegon and Ahmet Çağkan İnkaya and Jorge Carrillo and Georg Stary and Katja Knapp and Oriol Mitja and Jean-Michel Molina},
doi = {https://doi.org/10.1016/j.lanepe.2023.100738},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100738},
abstract = {The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
The current prevention efforts for STIs, HIV and viral hepatitis in the WHO European Region, especially in the Central and Eastern subregions, are hindered by healthcare disparities, data gaps, and limited resources. In this comprehensive narrative review, we aim to highlight both achievements and persisting challenges while also exploring new developments that could significantly impact the prevention of these infections in the near future. While pre-exposure prophylaxis (PrEP) for HIV has been broadly approved and implemented in 38 out of 53 countries in the region, challenges remain, including cost, limited licensing, and incomplete adherence. We explore innovative approaches like on-demand PrEP, long-acting injectable cabotegravir, and intravaginal rings that have shown promising results, alongside the use of six-monthly lenacapavir, the outcomes of which are pending. Additionally, the potential of doxycycline post-exposure prophylaxis has been discussed, revealing efficacy in reducing chlamydia and syphilis risk, but effectiveness against gonorrhoea being contingent on tetracycline resistance rates, and the need of further data to determine potential resistance development in other bacteria and its impact on the gut microbiome. We examine successful vaccination campaigns against HBV and HPV, the ongoing development of vaccines for chlamydia, syphilis, herpesvirus, and gonorrhoea, and challenges in HIV vaccine research, including lines of research with significant potential like sequential immunization, T-cell responses, and mRNA technology. This review underscores the research endeavors that pave the way for a more resilient and robust approach to combating STIs, HIV, and viral hepatitis in the region.
Mitjà, Oriol; Padovese, Valeska; Folch, Cinta; et al.
Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe Journal Article
In: The Lancet Regional Health – Europe, vol. 34, pp. 100742, 2023, ISSN: 2666-7762.
@article{MITJA2023100742,
title = {Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe},
author = {Oriol Mitjà and Valeska Padovese and Cinta Folch and Isotta Rossoni and Michael Marks and Miquel Angel Rodríguez Arias and Amalio Telenti and Angela Ciuffi and Karel Blondeel and Otilia Mårdh and Jordi Casabona},
doi = {https://doi.org/10.1016/j.lanepe.2023.100742},
issn = {2666-7762},
year = {2023},
date = {2023-01-01},
journal = {The Lancet Regional Health - Europe},
volume = {34},
pages = {100742},
abstract = {In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.
Fernández-Naval, Candela; Arando, Maider; Espasa, Mateu; et al.
Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona Journal Article
In: Future Microbiology, vol. 16, no. 13, pp. 967-976, 2021.
@article{Fernandez2021,
title = {Multilocus sequence typing of Treponema pallidum subsp. pallidum in Barcelona},
author = {Candela Fernández-Naval and Maider Arando and Mateu Espasa and Andrés Antón and Miguel Fernández-Huerta and Aroa Silgado and Cristina Pinatar and Francesc Zarzuela and Juan José González-López and Judit Serra-Pladevall and Elena Sulleiro and Tomàs Pumarola and Martí Vall-Mayans and Juliana Esperalba},
doi = {https://doi.org/10.2217/fmb-2021-0037},
year = {2021},
date = {2021-01-01},
journal = {Future Microbiology},
volume = {16},
number = {13},
pages = {967-976},
abstract = {Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Aim: To implement the multilocus sequence typing (MLST) methodology in syphilis samples previously characterized by enhanced CDC typing (ECDCT) and macrolide resistance. Materials & methods: MLST was performed on genital ulcer and blood samples by analyzing a region of the tp0136, tp0548 and tp0705 loci using Sanger sequencing. Results: Up to 59/85 (69.4%) of genital ulcer and 4/39 (10.3%) of whole blood samples were fully typed. The most frequent profiles were 1.3.1 (56%) and 1.1.1 (11%). All the 1.3.1 samples typed carried the A2058G mutation, responsible for macrolide resistance. MLST and ECDCT showed similar overall typing yields. Conclusion: Several allelic profiles of T. pallidum subsp. pallidum were identified and classified into two major genetic clades in Barcelona. Our results were similar to that described in Europe.
Haynes, Austin M.; Giacani, Lorenzo; Mayans, Marti Vall; et al.
Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study Journal Article
In: EBioMedicine, vol. 65, 2021, ISSN: 2352-3964.
@article{Haynes2021,
title = {Efficacy of linezolid on textitTreponema pallidum, the syphilis agent: A preclinical study},
author = {Austin M. Haynes and Lorenzo Giacani and Marti Vall Mayans and Maria Ubals and Carles Nieto and Clara Pérez-Mañá and Llorenç Quintó and Emily Romeis and Oriol Mitjà},
doi = {10.1016/j.ebiom.2021.103281},
issn = {2352-3964},
year = {2021},
date = {2021-01-01},
journal = {EBioMedicine},
volume = {65},
publisher = {Elsevier},
abstract = {Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Penicillin G, the current standard treatment for syphilis, has important drawbacks, but virtually no preclinical or clinical studies have been performed to identify viable alternatives. We tested, both textitin vitro and textitin vivo, three marketed antibiotics with adequate pharmacological properties to treat syphilis.
Hoyos-Mallecot, Yannick; Garcia, Jorge Nestor; Sulleiro, Elena; et al.
Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification Journal Article
In: Sexually Transmitted Infections, 2021, ISSN: 1368-4973.
@article{Hoyos-Mallecotsextrans-2020-054779,
title = {Drassanes Exprés: a public and confidential testing service for asymptomatic STIs with same-day result notification},
author = {Yannick Hoyos-Mallecot and Jorge Nestor Garcia and Elena Sulleiro and Juliana Esperalba and Paula Salmeron and Francesc Zarzuela and Albert Blanco and Maider Arando and Vicente Descalzo and Luis Lopez and Martí Vall-Mayans and María Jesús Barberá and Judit Serra-Pladevall and Montserrat LLinas and Benito Almirante and Tomas Pumarola and Mateu Espasa},
doi = {10.1136/sextrans-2020-054779},
issn = {1368-4973},
year = {2021},
date = {2021-01-01},
journal = {Sexually Transmitted Infections},
publisher = {The Medical Society for the Study of Venereal Disease},
abstract = {Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Background STIs are a major public health concern. Screening programmes for asymptomatic users are key components of STI control. Traditional limitations of screening programmes include low population coverage and delays in treatments, thus reducing the expected impact on STI control. In our centre, the normal time from test to results was 4 days, and 7 days until treatment was established.To reduce time to treatment and to increase population coverage, we developed ‘Drassanes Exprés’, a testing service for asymptomatic STIs. The objectives of this study were to provide a guide for the implementation of a service with these characteristics and to evaluate the results of this intervention.Methods The Drassanes Exprés programme was launched in Spain on 07 November 2016 as a public, confidential and free-of-charge testing service for asymptomatic STIs, with same-day result notification. For this walk-in service, confidentiality was obtained by registering all information into the Laboratory Internal Software instead of the Electronic Patient Records. Samples were processed in a point-of-care laboratory and result notification was provided via mail or short message service.Information about workflow, screening protocols and result interpretation is detailed. Additionally, demographic characteristics, STI prevalence, and time from patients’ sample collection to notification and treatment are analysed.Results Between 07 November 2016 and 07 November 2019, 13 993 users attended the Drassanes Exprés screening programme. Of these, 0.5% were transgender people, 29.3% women, 45.2% men who have sex with men and 25.1% men who have sex with women. The median age was 31 years (range: 26–39 years). Overall, 14.6% of users tested positive for at least one STI. The most prevalent infection was Chlamydia trachomatis (8.3%), followed by Neisseria gonorrhoeae (5.7%), syphilis (1.8%), HIV (0.4%) and hepatitis C virus (0.2%). The median time from test to results was 2.4 hours (range: 2–3.1 hours). Of 2049 users diagnosed with an STI, treatment was achieved in 97.0% of cases; the average time to treatment was 2.0 days.Conclusions Drassanes Exprés is the first public programme for rapid, asymptomatic, STI screening and treatment in Spain. Assessing high-risk practices and providing confidentiality, easy access and rapid results/treatments are key elements in the development of STI screening programmes.Data are available upon reasonable request. All data relevant to the study are included in the article, however more detailed protocols are available upon request.
Suñer, Clara; Ouchi, Dan; Mas, Miquel Àngel; et al.
A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain Journal Article
In: Nature Aging, vol. 1, no. 7, pp. 579-584, 2021, ISSN: 2662-8465.
@article{Suñer2021,
title = {A retrospective cohort study of risk factors for mortality among nursing homes exposed to COVID-19 in Spain},
author = {Clara Suñer and Dan Ouchi and Miquel Àngel Mas and Rosa Lopez Alarcon and Mireia Massot Mesquida and Núria Prat and Josep Maria Bonet-Simó and Marta Expósito Izquierdo and Irene Garcia Sánchez and Sara Rodoreda Noguerola and Montserrat Teixidó Colet and Joaquim Verdaguer Puigvendrelló and Norma Henríquez and Ramón Miralles and Eugènia Negredo and Marc Noguera-Julian and Michael Marks and Oriol Estrada and Jordi Ara and Oriol Mitjà},
doi = {10.1038/s43587-021-00079-7},
issn = {2662-8465},
year = {2021},
date = {2021-01-01},
urldate = {2021-01-01},
journal = {Nature Aging},
volume = {1},
number = {7},
pages = {579-584},
abstract = {Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2–5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Long-term care (LTC) facilities have shown remarkably high mortality rates during the coronavirus disease 2019 (COVID-19) outbreak in many countries1, and different risk factors for mortality have been identified in this setting2–5. Using facilities as the unit of analysis, we investigated multiple variables covering facility characteristics and socioeconomic characteristics of the geographic location to identify risk factors for excess mortality from a comprehensive perspective. Furthermore, we used a clustering approach to detect patterns in datasets and generate hypotheses regarding potential relationships between types of nursing homes and mortality trends. Our retrospective analysis included 167 nursing homes providing LTC to 8,716 residents during the COVID-19 outbreak in Catalonia (northeast Spain). According to multiple regression analysis, COVID-19-related and overall mortality at the facility level were significantly associated with a higher percentage of patients with complex diseases, lower scores on pandemic preparedness measures and higher population incidence of COVID-19 in the surrounding population. When grouping nursing homes into eight clusters based on common features, we found higher mortality rates in four clusters, mainly characterized by a higher proportion of residents with complex chronic conditions or advanced diseases, lower scores on pandemic preparedness, being located in rural areas and larger capacity, respectively.
