Origin of Repeat Bacterial STIS Among Heterosexual Men

异性恋男性重复细菌性 STIS 的起源

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

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

描述（由申请人提供）：最近的报道说，阿奇霉素可能增加了沙眼衣原体（CT）和支原体生殖器（MG）的治疗失败，呼吁更好地了解这些重复感染的起源，以便提供者可以更有效地靶向他们的治疗方法。例如，如果治疗失败是起源，更好 需要药物；如果重新接触未经治疗的伴侣，则需要更好的伴侣治疗策略；如果暴露于新伙伴，则会进行纠正。我们的初步数据表明，具有CT的异性恋男性重复感染的可能来源是多因素，治疗失败是实质性的。但是，这些分类是基于自我报告的性历史，可能已经过度估计了治疗失败。基因分型数据可以为分类提供更客观的方法，但是与基因型信息的方法学问题有关，使重复感染的起源难以解释。我们专注于异性恋男性，这不仅是因为他们的重复感染率很高，而且还因为她们对妇女健康的影响。数十年的女性针对女性的干预措施未能降低CT流行病。显然，干预措施还必须针对男性，尤其是那些反复感染的男性，他们可能是核心发射器。我们还将检查MG，因为有越来越多的证据表明它是生殖健康发病率的重要来源，并且已经记录了重复感染的高率。该研究的目的是减少异性恋男性中CT和/或MG的早期重复感染。目标1：为了量化异性恋男性中早期重复感染和/或毫克的早期重复感染的可能起源 - 我们将结合电子性日记中的数据，测试计算机辅助访谈的测试以及CT和/或MG的最先进基因分型，以计算测试测试时重复感染最可能的重复感染来源。 我们假设有重复感染的多个起源，并且治疗失败是实质性的（即> 6％），这需要对本治疗指南进行重新评估。目的2：对重复CT和/或MG感染的起源进行深入探索，并探索异性恋男性中EPT和/或纠正的适应。将对（n = 30）并且没有（n = 30）的男性进行深入的访谈，以重复进行CT和/或MG感染，以增强我们对导致或不会导致重复感染的风险行为和环境的微妙，细微差别方面的理解。这些数据将允许发展更适合性别的咨询和干预措施，以减少异性恋男性的重复感染。为了实现这些目标，我们扩展了从R56开始的工作。参加CT/ mg的男性将筛选两个城市性病诊所（n = 4777）的男性。有生物体（〜2327）的男性将完成每周的电子性日记，并在基线后4周进行治疗筛查和访谈测试。重复CT和/或MG感染的男性的标本（每种）将是基因型的。这项研究非常适合NIAID的目标，即减少健康差异/提供更有效的性病治疗。