Diagnosis and Management of Bacterial Sexually Transmitted Diseases in Russia: Results of Multicenter Pharmacoepidemiological Study

Clinical Microbiology and Antimicrobial Chemotherapy. 2010; 12(3):226-245

​ Belkova Yu.А., Aleksandrova O.Y., Berezhanskiy B.V., Bochanova E.N., Chebotarev V.V., Chechula I.L., Tsygankova E.P., Dekhnich A.V., Evstafiev V.V., Grinev A.V., Eliseeva E.V., Kozlov R.S., Loginov Y.A., Ortenberg E.A., Savicheva A.M., Sekhin S.V., Toropova I.A.
STD syphilis gonococcal infection chlamydial infection diagnosis management pharmacoepidemiology
Section
Diseases and Pathogens
Type
Journal article
Publication
Clinical Microbiology and Antimicrobial Chemotherapy. 2010; 12(3):226-245

Objective.

Objectives: We aimed to reveal the current practice of diagnosis and management of bacterial sexually transmitted diseases (STDs) in different regions of Russia and to compare it with the current national guidelines.

Materials and Methods.

A multicenter retrospective study was conducted in 10 different cities of Russia. Randomly selected clinical records of 1250 adult patients (61% male, 39% female, mean age 28.8±9.2) treated for early syphilis (n=341), uncomplicated gonococcal (n=309), chlamydial (n=310), mycoplasma (n=137) and ureaplasma (n=153) infection during the period since January 2007 till December 2007 were analyzed.

Results.

We found wide use of outdated methods in diagnostic of STDs. Thus the main methods to diagnose syphilis were microprecipitation (81.5%) and complement fixation test (13.3%) with no treponemal tests confirmation. In 80.7% of patients methylene blue stain and/or Gram stain microscopy was the only used test to diagnose gonococcal infection. Although culture was done in 18.7% of patients, susceptibility testing was performed only in 2.3% of cases. Polymerase chain reaction was used to diagnose infections caused by intracellular pathogens only in 37.1% of cases, whereas low informative microscopy and ELISA in 21.5% and 13.3% of cases. A total of 1567 disease-specific physicians’ prescriptions was recorded (1352 [86.2%] were antimicrobials). Early syphilis was commonly treated with benzathine penicillin (38.4%), procaine penicillin (28.3%), ceftriaxone (26.9%) and penicillin G (5.5%); gonococcal infection – with ceftriaxone (57.5%), spectinomycin (9.3%), doxycycline (7.2%), azithromycin (5.1%); chlamydial infection – with azithromycin (28.2%), doxycycline (22.2%), claritromycin (14.9%), josamycin (11.1%), ofloxacin (7.9%); mycoplasma and ureaplasma infection – by doxycycline (32.4% and 31.3%), josamycin (21.4% and 21.3%), azithromycin (15.2 and 11.3%), claritromycin (14.5 and 11.3%), levofloxacin (4.1 and 6.9%). Other agents accounted for less than 5% each.

Conclusions.

Prominent variability in the administrations of antibacterial agents with tendency to increase their course doses was revealed. Therapy administered to patients was not compliant with the with national guidelines in 28.2% of patients and among correctly chosen agents only 24% were used in recommended course doses. Inadequacy of diagnostics as well as relatively low compliance to national guidelines indicates the need of revision and correction of current practice of STD management in Russia.

  • 1. Глобальная стратегия профилактики инфекций, передаваемых половым путем, и борьбы с ними, 20062015 гг. ВОЗ; 2007.
  • 2. Федеральное государственное учреждение здравоохранения «Федеральный центр гигиены и эпидемиологии Федеральной службы по надзору в сфере защиты прав потребителей и благополучия человека». Available from: URL: http://www.fcgsen.ru/DOC/270110/infdec09..xls
  • 3. Simms I., Stephenson J.M. Pelvic inflammatory disease epidemiology: what do we know and what do we need to know? Sexually Transmitted Infections, 2000; 76:80-7.
  • 4. Laga M., Meheus A., Piot P. Epidemiology and control of gonococcal ophthalmia neonatorum. Bulletin of the World Health Organization, 1989; 67:471-8.
  • 5. Whitcher J.P., Srinivasan M., Upadhyay M.P. Corneal blindness: a global perspective. Bulletin of the World Health Organization, 2001; 79:214-21.
  • 6. Приказ Минздравсоцразвития РФ № 43 от 17.01.2007 «Об утверждении стандарта медицинской помощи больным с раним сифилисом при оказании специализированной помощи».
  • 7. Приказ Минздравсоцразвития РФ №176 от 25.02.2005 «Об утверждении стандарта медицинской помощи больным гонококковой инфекцией».
  • 8. Кубанова А.А., ред. Методические материалы по диагностике и лечению наиболее распространенных инфекций, передаваемых половым путем (ИППП), и заболеваний кожи. Протоколы ведения больных, лекарственные средства. М.: ГЭОТАР–Медиа; 2003.
  • 9. Кубанова А.А., ред. Дерматовенерология. Клинические рекомендации РОДВ. М: ГЭОТАР–Медиа; 2006.
  • 10. Кулаков В.И., Прилепская В.Е., Радзинский В.Е., ред. Руководство по амбулаторнополиклинической помощи в акушерстве и гинекологии. М: ГЭОТАР–Медиа; 2007.
  • 11. Mukenge-Tshibaka L., Alary M., Lowndes C.M., Van Dyck E., Guédou A., Geraldo N., et al. Syndromic versus laboratory-based diagnosis of cervical infections among female sex workers in Benin. Sex Transm Dis 2002; 29:324-30.
  • 12. Hylton-Kong T., Brathwaite A.R., Del Rosario G.R., Kristensen S., Kamara P., Jolly P.E., et al. Marginal validity of syndromic management for reproductive tract infections among pregnant women in Jamaica. Int J STD AIDS 2004; 15:371-5.
  • 13. Сифилис. ФГУ «ГНЦД Росмедтехнологий» Available from: URL: http://www.cnikvi.ru/files/sifilis.doc
  • 14. CDC. Sexually transmitted diseases treatment guidelines, 2006. Morbidity and Mortality Weekly Report 2006; 55(No. RR-11).
  • 15. Geisler W.M. The prozone phenomenon in syphilis testing. South Med J 2004; 97(4):327-8.
  • 16. Geisler K., Baxi L., Fox H.E. False-negative syphilis screening: the prozone phenomenon, nonimmune hydrops, and diagnosis of syphilis during pregnancy. Am J Obstet Gynecol 1990; 163(3):975-7.
  • 17. Savicheva A., Sokolovsky E., Frigo N., Priputnevich T., Brilene T., Deák J., et al. Guidelines for laboratory diagnosis of Neisseria gonorrhoeae in East-European countries. Part 1: gonorrhoea, sampling, and microscopy for diagnosis. Acta Medica Lituanica 2007; 4(1):65-74.
  • 18. CDC. Screening tests to detect Chlamydia trachomatis and Neisseria gonorrhoeae infections, 2002. MMWR 2002; 51(No. RR-15).
  • 19. Savicheva A., Sokolovsky E., Frigo N., Priputnevich T., Brilene T., Deák J., et al. Guidelines for laboratory diagnosis of Neisseria gonorrhoeae in East-European countries. Part 2: culture, non-culture methods, determination of antibiotic resistance, and quality assurance. Acta Medica Lituanica 2007; 4(2):123-34.
  • 20. Hook E.W., Handsfield H.H. Gonococcal Infections in the Adult. In: Sexually Transmitted Diseases. Holmes K.K., Sparling F.P., Stamm W.E., et al, editors. 4th ed. McGraw-Hill Medical; 2008. p. 627-45.
  • 21. Lyss S.B., Kamb M.L., Peterman T.A., Moran J.S., Newman D.R., Bolan G., et al. Chlamydia trachomatis among patients infected with and treated for Neisseria gonorrhoeae in sexually transmitted disease clinics in the United States. Ann Intern Med 2003; 139(3):178-85.
  • 22. Кубанова А.А., Рахматуллина М.Р. Урогенитальные инфекционные заболевания, вызванные генитальными микоплазмами. Клинические рекомендации. Consilium Medicum 2009; 6:32-6.
  • 23. STI/HIV: Laboratory tests for the detection of reproductive tract infections. World Health Organization; 1999.
  • 24. Schachter J., Stamm W.E. Chlamydia. In: Murray P.R., et al., editors. Manual of Medical Microbiology. 7th ed. Washington, DC: ASM Press; 1999. p. 795-806.
  • 25. Marrazzo J.M., Stamm W.E. New approaches to the diagnosis, treatment, and prevention of chlamydial infections. Curr Topics Infect Dis 1998; 18:37-59.
  • 26. Stamm W.E. Chlamydia trachomatis Infections of the Adult. In: Sexually Transmitted Diseases. Holmes K.K., Sparling F.P., Stamm W.E., et al, editors. 4th ed. McGraw-Hill Medical; 2008. p. 575-93.
  • 27. Ross J.D., Jensen J.S. Mycoplasma genitalium as a sexually transmitted infection: implications for screening, testing, and treatment. Sexually Transmitted Infections 2006; 82(4):269-71.
  • 28. Yokoi S., Maeda S., Kubota Y., et al. The role of Mycoplasma genitalium and Ureaplasma urealyticum biovar 2 in postgonococcal urethritis. Clinical Infectious Diseases 2007; 45(7):866-71.
  • 29. Totten P.A., Taylor-Robinson D., Jensen J.S. Genital Mycoplasmas. In: Sexually Transmitted Diseases. Holmes K.K., Sparling F.P., Stamm W.E., et al, editors. 4th ed. McGraw-Hill Medical, 2008. p.709-36.
  • 30. Guidelines for the management of sexually transmitted infections. World Health Organization; 2003.
  • 31. Apter A.J., Kinman J.L., Bilker W.B., Herlim M., Margolis D.J., Lautenbach E., et al. Is there cross-reactivity between penicillins and cephalosporins? Am J Med 2006; 119(4):354.e11-9.
  • 32. Shann S., Wilson J. Treatment of neurosyphilis with ceftriaxone. Sexually Transmitted Infections 2003; 79:415-6.
  • 33. Smith N.H., Musher D.M., Huang D.B., Rodriguez P.S., Dowell M.E., Ace W., et al. Response of HIV-infected patients with asymptomatic syphilis to intensive intramuscular therapy with ceftriaxone or procaine penicillin. International Journal of STD & AIDS 2004; 15: 328-32.
  • 34. Резистентность возбудителей ИППП к антибактериальным препаратам. Информационный бюллетень 2008 год. М.: ООО «ДЭКСПРЕСС»; 2008.
  • 35. Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) Steering Group. GRASP year 2005 report. London, England: Health Protection Agency; 2006.
Views
0 Abstract
0 PDF
0 Crossref citations
Shared