Hidden Epidemics
Stigma
1
 Common bacterial infections
 Neisseria gonorrhoeae (causes
gonorrhoea or gonococcal
infection)
 Chlamydia trachomatis ...
Unintended pregnancy, Potentiated HIV risk (three to six times the risk)
STDs Background
2
(PID)
6 Ways STDs Impact Women Differently from Men
 A woman’s anatomy can place her at a unique risk for STD infection,
compar...
6 Ways STDs Impact Women Differently from Men
 Women who are pregnant can pass STDs to their babies.
 Human papillomavir...
2
In World
ESTIMATED
NEW CASES
OF
CURABLE
STI
AMONG
ADULTS,
1999
4
4
GLOBAL PREVALENCE AND INCIDENCE OF SELECTED CURABLE
SEXUALLY TRANSMITTED INFECTIONS OVERVIEW AND ESTIMATES 1999-2001
NORTH...
Incidence conveys
information about the
risk of contracting the
disease, whereas
prevalence indicates how
widespread the d...
http://globalgrind.com/2013/02/14/cdc-says-us-highest-rates-stds-stats-in-world-details/ 5
Most shockingly,
HPV,
compromis...
3
3
Chlamydia
3
Gonorrhea
Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3
Gonorrhea
Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3
Syphilis
Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3
In Iran
Prisons
tested for
HIV
6
injecting drug 62%
sexual contact 26%
Result
507
patients
Candida Trichomona
Neisseria
gonorrhoeae
Chlamydia
Men %47 %8 %9 %34
Women %53 %18 %4 %22
7
between Ma...
9
• 100 women during
2009-2010
• HIV-Ab, Chlamydia
trachomatis-IgG and
syphilis infection
Result:
• The overall prevalence...
 358 parent were assessed for knowledge about HPV
 73% of parents had no information about HPV
 26% had obtained their ...
Gonorrhea
The ticking time bomb
SEM TEM Methylene Blue Gram Stain
Clinical manifestations
23
Gonococcal pharyngitis Neonatal ophthalmia
Virulence FactorsCellsurfacecomponents
Capsule – antiphagocytic
Pili
• Composed of repeating peptide subunits of pilin.
• ...
Common diagnostic tests (as of June 2012) for detection
of N. gonorrhoeae
23
• Azithromycin is safe and effective in pregnant women, but
doxycycline is contraindicated.
Treatment
• CDC: patients with...
Pic: Unemo M, Shafer WM. Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the fu...
Antimicrobial susceptibility
and genetic characteristics Articles
Number of
Articles
Years Number of
Isolates
In Countries...
Enzyme
base
Iodometric
Chromomeric
AcidometricGrowth
base
Dilution
Disk
Diffusion
Etest
Clover leaf
17
Detection of beta-l...
Clover leaf
17
Acidometric Method
17
Iodometric method
• Penicillin
solution
• several
colonies
• Starch
solution
• iodine
• Penicillin
p...
Nitrocefin
 Slide Surface Assay
 Direct Contact Assay
 Broth Suspension Assay
 Lysed Cell Assay
 Filter Paper Assay
(...
Average Susceptibility
Antibiotic Average (%)
Ciprofloxacin 79
Tetracycline 68
Penicillin G 46
Azithromycin 12
Ceftriaxone...
ESC resistance determinants
penA (encodes altered forms of PBP2)
ponA (encoding an altered form of PBP1)
penB (encodes ...
http://www.medscape.com/viewarticl
e/777317_6
ESC resistance
determinantsmtrR
penB
penA
ponA
Mtr120: C-to-T transition
mut...
NG-MAST
Porin PorB (porB) gene (908 bp)
Subunit B of the transferrin binding protein (tbpB) gene
(110 bp)
(ST 1407, ST ...
 Therapeutic dose 64 µg/ml (2grX1)
 High-level spectinomycin-resistant MIC >1,024 4g/ml
 Amino acids 19 to 33 in the N ...
 21 different nanomaterials
 1-120 nm in diameter
20
SEM
hollow and shrank 20
TEM
20
Cell wall depth of the control group: 152635 nm cell wall depth in bacteria exposed to Ag NPs
was reduced to 71625 nm
TEM
...
TEM
20
20
 This study highlighted that the CDS disc diffusion technique yielded excellent
category agreement with their analogous E...
Thank You
STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae
STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae
STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae
STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae
STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae
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STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae

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STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae

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STD Prevalence in World, USA and Iran, and Neisseria gonorrhoeae

  1. 1. Hidden Epidemics Stigma 1
  2. 2.  Common bacterial infections  Neisseria gonorrhoeae (causes gonorrhoea or gonococcal infection)  Chlamydia trachomatis (causes chlamydial infections)  Treponema pallidum (causes syphilis)  Haemophilus ducreyi (causes chancroid)  Klebsiella granulomatis (causes granuloma inguinale or donovanosis).  Common Fungal infections  Candida albicans Vulvovaginitis, penile candidiasis http://www.who.int/mediacentre/factsheets/fs110/en/  Common viral infections  HIV (causes AIDS)  HSV 1-2  HPV (causes genital warts and certain subtypes lead to cervical cancer in women)  HBV (causes hepatitis and chronic cases may lead to cancer of the liver)  Commom Parasitic infection  Crab louse, colloquially known as "crabs" or "pubic lice" (Pthirus pubis)  Scabies (Sarcoptes scabiei)  Trichomoniasis (Trichomonas vaginalis), colloquially known as "trich" 1
  3. 3. Unintended pregnancy, Potentiated HIV risk (three to six times the risk) STDs Background 2 (PID)
  4. 4. 6 Ways STDs Impact Women Differently from Men  A woman’s anatomy can place her at a unique risk for STD infection, compared to a man.  Women are less likely to have symptoms of common STDs — such as chlamydia and gonorrhea — compared to men.  Women are more likely to confuse symptoms of an STD for something else.  STDs can lead to serious health complications and affect a woman’s future reproductive plans. 3
  5. 5. 6 Ways STDs Impact Women Differently from Men  Women who are pregnant can pass STDs to their babies.  Human papillomavirus (HPV) is the most common sexually transmitted infection in women, and is the main cause of cervical cancer.  Women typically see their doctor more often than men.  There is a vaccine to prevent HPV; and available treatments for other STDs can prevent serious health consequences, such as infertility, if diagnosed and treated early. 3
  6. 6. 2
  7. 7. In World
  8. 8. ESTIMATED NEW CASES OF CURABLE STI AMONG ADULTS, 1999 4
  9. 9. 4
  10. 10. GLOBAL PREVALENCE AND INCIDENCE OF SELECTED CURABLE SEXUALLY TRANSMITTED INFECTIONS OVERVIEW AND ESTIMATES 1999-2001 NORTHAMERICA LATINAMERICA &THECARIBBEAN NORTHAFRICA &THEMIDDLE EAST SUB-SAHARAN AFRICA WESTERN EUROPE EASTERNEUROPE &CENTRALASIA EASTASIA& PACIFIC SOUTH& SOUTHEASTASIA AUSTRALIA& NEWZEALAND GLOBAL TOTAL CHLAMYDIAL INFECTIONS 4 9.5 3 16 5 6 5 43 0.5 92 GONORRHOEA 1.5 7.5 1.5 17 1 3.5 3 27 0.1 62 SYPHILIS 0.1 3 0.3 4 0.1 0.1 0.2 4 0.01 12 NEW CASES OF CURABLE STI AMONG ADULTS 14 38 10 69 17 22 18 151 1 340 Digits are in MILLION 4
  11. 11. Incidence conveys information about the risk of contracting the disease, whereas prevalence indicates how widespread the disease is. 3
  12. 12. http://globalgrind.com/2013/02/14/cdc-says-us-highest-rates-stds-stats-in-world-details/ 5 Most shockingly, HPV, compromising 71 percent of all the current infections, and 72 percent of new infections.
  13. 13. 3
  14. 14. 3
  15. 15. Chlamydia 3
  16. 16. Gonorrhea Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3
  17. 17. Gonorrhea Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3
  18. 18. Syphilis Sexually Transmitted Disease Surveillance 2011, Division of STD Prevention December 2012 3
  19. 19. In Iran
  20. 20. Prisons tested for HIV 6 injecting drug 62% sexual contact 26%
  21. 21. Result 507 patients Candida Trichomona Neisseria gonorrhoeae Chlamydia Men %47 %8 %9 %34 Women %53 %18 %4 %22 7 between May 2005 and May 2007
  22. 22. 9 • 100 women during 2009-2010 • HIV-Ab, Chlamydia trachomatis-IgG and syphilis infection Result: • The overall prevalence of C.trachomatis was 19%. • No case with syphilis or HIV infection.
  23. 23.  358 parent were assessed for knowledge about HPV  73% of parents had no information about HPV  26% had obtained their information via internet  Others from studying medical resources  Average score of mothers information about HPV infection was higher than that of fathers  Parent knowledge about the hazards of HPV was higher than their knowledge about modes of transmission 10 Most common sexually transmitted diseases (STD) Cervical cancer in women resulting in 233,000 deaths per year HPV infection often clears over without treatment HPV types 16 and 18 can be a hazard to change precancerous lesions
  24. 24. Gonorrhea The ticking time bomb SEM TEM Methylene Blue Gram Stain
  25. 25. Clinical manifestations 23 Gonococcal pharyngitis Neonatal ophthalmia
  26. 26. Virulence FactorsCellsurfacecomponents Capsule – antiphagocytic Pili • Composed of repeating peptide subunits of pilin. • Mediate initial attachment of gonococci to epithelial cells. • Specific cell receptor unidentified; high specificity of binding for genito-epithelial cells. OuterMembrane Proteins Por (protein I) • Most abundant outer membrane protein; • Forms trimers through which some nutrients enter the cell. • Role in virulence Opa (protein II) • When expressed, is a major component of the cell surface. • Function in virulence Rmp (protein III) - Reduction–modifiable protein Tbp1, Tbp2 – two transferrin-binding proteins Lpb – Lactoferrin-binding protein LOS (Lipooligosaccharide) xtracell lar roducts Secretory IgA 1 protease 24
  27. 27. Common diagnostic tests (as of June 2012) for detection of N. gonorrhoeae 23
  28. 28. • Azithromycin is safe and effective in pregnant women, but doxycycline is contraindicated. Treatment • CDC: patients with uncomplicated genital or rectal infections be treated with ceftriaxone (250 mg) given intramuscularly as a single dose or 400 mg of oral cefixime as a single dose. 3 • azithromycin as a single 1-g oral dose or doxycycline 100 mg orally twice daily for 7 days) is recommended for administration with ceftriaxone.
  29. 29. Pic: Unemo M, Shafer WM. Antibiotic resistance in Neisseria gonorrhoeae: origin, evolution, and lessons learned for the future. Ann N Y Acad Sci. 2011;1230:E19-28 Merbromin (Mercurochrome) Gonococcal infections are usually treated with single-dose therapy with an agent found to cure >95 per cent of cases. 11
  30. 30. Antimicrobial susceptibility and genetic characteristics Articles Number of Articles Years Number of Isolates In Countries Techniques AMR 5 1990-2012 2047 ،‫بوتان‬،‫هند‬ ‫و‬ ‫پاکستان‬ ‫کشورهای‬ ‫اروپایی‬ MIC E Test Nitrocefin ST (ESC) NG-MAST Ciprofloxacin Tetracycline Penicillin G Azithromycin Ceftriaxone Cefixime Spectinomycin Gentamicin Ertapenem 12-165 Articles
  31. 31. Enzyme base Iodometric Chromomeric AcidometricGrowth base Dilution Disk Diffusion Etest Clover leaf 17 Detection of beta-lactamases
  32. 32. Clover leaf 17
  33. 33. Acidometric Method 17 Iodometric method • Penicillin solution • several colonies • Starch solution • iodine • Penicillin phenol red • Several colonies
  34. 34. Nitrocefin  Slide Surface Assay  Direct Contact Assay  Broth Suspension Assay  Lysed Cell Assay  Filter Paper Assay (10.0 mg/mL) in DMSO (1.0 mg/mL) diluted with PBS 25 units of beta- lactamase Vortexed mixture Red color within 20-30 min 17 Detection of all known beta-lactamases Neisseria gonorrhoeae, Moraxella, Staphylococcus, Haemophilus, Enterococcus spp., and some anaerobic bacteria for the production of beta-lactamase.
  35. 35. Average Susceptibility Antibiotic Average (%) Ciprofloxacin 79 Tetracycline 68 Penicillin G 46 Azithromycin 12 Ceftriaxone 5 Cefixime 5 12-16
  36. 36. ESC resistance determinants penA (encodes altered forms of PBP2) ponA (encoding an altered form of PBP1) penB (encodes mutations in the major outer membrane porin (PorB1b)) mtrR (MtrR represses expression of the mtrCDE, The mtrCDE-encoded efflux pump) 12-16
  37. 37. http://www.medscape.com/viewarticl e/777317_6 ESC resistance determinantsmtrR penB penA ponA Mtr120: C-to-T transition mutation 120 bp upstream of the mtrC start codon: to be stronger than the wild- type promoter 12-16 18
  38. 38. NG-MAST Porin PorB (porB) gene (908 bp) Subunit B of the transferrin binding protein (tbpB) gene (110 bp) (ST 1407, ST 1901, ST 7363) in Europe and Japan is dominant and relative with the recent reports of recommended third generation cephalosporins resistance (ST 225) associated with ciprofloxacin resistance 12-16
  39. 39.  Therapeutic dose 64 µg/ml (2grX1)  High-level spectinomycin-resistant MIC >1,024 4g/ml  Amino acids 19 to 33 in the N terminus of the ribosomal protein 5S that form a loop structure (loop 2) which nonspecifically binds to helix 34 of 16S rRNA and is within 50 nm of the spectinomycin- binding site. Amino acid alterations at this loop can disrupt the binding of spectinomycin to the ribosome, which results in spectinomycin resistance. 19
  40. 40.  21 different nanomaterials  1-120 nm in diameter 20
  41. 41. SEM hollow and shrank 20
  42. 42. TEM 20
  43. 43. Cell wall depth of the control group: 152635 nm cell wall depth in bacteria exposed to Ag NPs was reduced to 71625 nm TEM 20
  44. 44. TEM 20
  45. 45. 20
  46. 46.  This study highlighted that the CDS disc diffusion technique yielded excellent category agreement with their analogous Etest minimal inhibitory concentrations in comparison to CLSI technique.  Applicable microbiological method to detect antimicrobial susceptibilities of N. gonorrhoeae in resource-poor countries.  This technique will facilitate enhanced antimicrobial resistance surveillance and direct and meaningful comparison of resistance data generated within different national and international laboratories. 26 • CFU: 1 x 107 • Annular diameter oc 18mm was selected as the uniform cut-off point. Calibrated Dichotomous Sensitivity Test
  47. 47. Thank You
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