We read with interest an article by Ikeuchi et al.1 We agree with their conclusion that the relatively low dose of amoxicillin could lead to the cure of syphilis. However, we would like to raise concern that the findings might not be generalized to different populations. The majority of the patients had concurrent HIV infection, and the study setting is well known prestigious center for HIV care in Japan, with decades of HIV care in Tokyo, suggesting that the patients who participated in the study are likely to be adherent to the medications prescribed, because they are instructed thoroughly in taking antiretroviral therapy. In addition, those who did not have HIV infection in the study did not have a previous history of syphilis, and they might also be likely to be adherent to the regimen compared with those who had repeated STDs. As pointed out in the study, the recommended duration of amoxicillin therapy by Japanese STD guideline is very long (4-8 weeks), and we are not sure whether patients with syphilis in general can be adherent to this regimen. Therefore, we consider that the findings by Ikeuchi et al. may not be generalizable, particularly for those who are not very aware of the importance of adherence to the medication, or those who take the risk of STDs lightly (and have repeated STDs). Future studies with different settings and populations might clarify our concerns.
We read with interest an article by Ikeuchi et al.1 We agree with their conclusion that the relatively low dose of amoxicillin could lead to the cure of syphilis. However, we would like to raise concern that the findings might not be generalized to different populations. The majority of the patients had concurrent HIV infection, and the study setting is well known prestigious center for HIV care in Japan, with decades of HIV care in Tokyo, suggesting that the patients who participated in the study are likely to be adherent to the medications prescribed, because they are instructed thoroughly in taking antiretroviral therapy. In addition, those who did not have HIV infection in the study did not have a previous history of syphilis, and they might also be likely to be adherent to the regimen compared with those who had repeated STDs. As pointed out in the study, the recommended duration of amoxicillin therapy by Japanese STD guideline is very long (4-8 weeks), and we are not sure whether patients with syphilis in general can be adherent to this regimen. Therefore, we consider that the findings by Ikeuchi et al. may not be generalizable, particularly for those who are not very aware of the importance of adherence to the medication, or those who take the risk of STDs lightly (and have repeated STDs). Future studies with different settings and populations might clarify our concerns.
Reference
1. Ikeuchi K, Fukushima K, Tanaka M, Yajima K, Imamura A. Clinical efficacy and tolerability of 1.5 g/day oral amoxicillin therapy without probenecid for the treatment of syphilis. Sex Transm Infect 2022; 98:173–177.
It would be good to have known the role of Mycoplasma genitalium in this population where asymptomatic infections by other pathogens were common and at least have mentioned it in the Discussion
Despite significant differences in testing opportunities, screening and access to care, this paper clearly sets out some important epidemiology of STIs accross Europe, particularly among MSM using PrEP. Despite this, there is no mention of sexually transmitted enteric infections, despite a recent outbreak of extensively drug resistant Shigella sonnei which has affected sexual networks of MSM accross Europe. There have been outbreaks of Shigella described in networks of MSM since the 1960s and can cause sugnificant morbidity. There are poor surveillance systems to monitor shigella outbreaks including transmssion of drug resistant organisms. More work is needed on both surveillance and shigella control strategies including awareness amongst both the communities affected and stakeholders including commissioners and public health.
The study by Dean et al. (1) on the treatment of PID was complicated and thought-provoking. Could it be that "mild" PID comprised many cases that were not PID at all? This issue bedevilled studies in the past, so why not here? Am I right in thinking that randomisation was used to try to maintain an evenness of disease severity between the two treatment arms, that is standard (SoC) with ofloxacin plus metronidazole, and an intervention arm (IA) with intramuscular ceftriaxone plus azithromycin and metronidazole? This is an important point when the outcome of each arm is to be compared. Presumably, after diagnosis treatment began without delay, not waiting for the results of microbiological tests which, in fact, showed M.genitalium in about 10% of cases in each arm, a proporttion seen by others (3) in acute PID. Standard treatment was judged to be slightly superior to the alternative treatment. Tests of microbiological cure 6 to 8 weeks after the study started showed a few azithromycin- resistant cases of M.genitalium, roughly comparable in the two arms. Not being aware of this at the start of treatment seems excusable. The reader must also realize that it was a situation experienced up to 9 years ago before an abrupt termination of the study. Today the scene is different, resistance of M.genitalium to azithromycin and other antibiotics being common (4). It has become clear that M.genitalium should be sought early followed rapidly by treatment guided by nothing othe...
The study by Dean et al. (1) on the treatment of PID was complicated and thought-provoking. Could it be that "mild" PID comprised many cases that were not PID at all? This issue bedevilled studies in the past, so why not here? Am I right in thinking that randomisation was used to try to maintain an evenness of disease severity between the two treatment arms, that is standard (SoC) with ofloxacin plus metronidazole, and an intervention arm (IA) with intramuscular ceftriaxone plus azithromycin and metronidazole? This is an important point when the outcome of each arm is to be compared. Presumably, after diagnosis treatment began without delay, not waiting for the results of microbiological tests which, in fact, showed M.genitalium in about 10% of cases in each arm, a proporttion seen by others (3) in acute PID. Standard treatment was judged to be slightly superior to the alternative treatment. Tests of microbiological cure 6 to 8 weeks after the study started showed a few azithromycin- resistant cases of M.genitalium, roughly comparable in the two arms. Not being aware of this at the start of treatment seems excusable. The reader must also realize that it was a situation experienced up to 9 years ago before an abrupt termination of the study. Today the scene is different, resistance of M.genitalium to azithromycin and other antibiotics being common (4). It has become clear that M.genitalium should be sought early followed rapidly by treatment guided by nothing other than the result of antibiotic sensitivity testing. This cannot be questioned and is an action with which the authors, according to their final comments, support. However, it is interesting that the authors of a recent publication (5) recommend using ceftriaxone, doxycycline and metronidazole as standard treatment for acute PID. Curiously, they found infection by M.genitalium was reduced considerably by metronidazole to which it is not sensitive in vitro. It seems the last word has not been said.
References
1. Dean G, Soni S, Pitt R, et al. Treatment of mild-to-moderate pelvic inflammatory disease with a short-course azithromycin-based regimen versus ofloxacin plus metronidazole : results of a multicentre, randomized control trial. Sex Transm Infect 2020
2..Taylor-Robinson D. Investigating the microbial aetiology of pelvic inflammatory disease. Sex Transm Infect. 2003; 79: 424-5.
3. Lewis J, Horner PJ, White PJ. Incidence of pelvic inflammatory disease associated with Mycoplasma genitalium infection : evidence synthesis of cohort study data. Clin Infect Dis. 2020
4. Durukan D, Doyle M, Murray G, et al. Doxycycline and sitafloxacin combination therapy for treating highly resistant Mycoplasma genitalium. Emerg Infect Dis.2020 ; 26: 1870-4.
5. Wiesenfeld HC, Meyn LA, Darville T, et al. A randomized controlled trial of ceftriaxone and doxycycline, with or without metronidazole, for the treatment of acute pelvic inflammatory disease. Clin Infect Dis. 2020: xx (xx) :1-9.
Dear editor,
We thank Dr. Latini et al. for providing the data for the potential effects of SARS-CoV-2 pandemic on sexual lifestyle and epidemiology of sexually transmitted infections (STIs).1 In the study the author highlighted the importance to check the lasting effects of SARS-CoV-2 on STIs. As China is the first country to generally alleviate lockdown of most cities since beginning of April and the returns to usual lifestyle for nearly 6 months, we’re able to tract the epidemiology of STIs during the post-outbreak period in China.
According to the monthly report disclosed by Chinese Center for Disease Control and Prevention (Accessed from http://www.nhc.gov.cn/jkj/pqt/new_list.shtml), during the lockdown period of the first quarter, the number of newly diagnosed cases of HIV, syphilis and gonorrhea were 9695, 102273 and 16439, which reduced substantially by 27.3%, 19.3% and 38.2% compared to the previous year. After lockdown alleviation, the number of new cases returned, but not exceeding the previous years. The total new cases of HIV, syphilis and gonorrhea changed by -4.4%, -5.6% and -18.9% in the second quarter and -7.8%, -9.5% and +0.7% in the third quarter compared with 2019, respectively. As the number of new STIs in China is constantly growing in the past years, the reduction of new cases of STIs in 2020 after lockdown alleviation indicates a lasting effect of SARS-CoV-2. This may result from...
Dear editor,
We thank Dr. Latini et al. for providing the data for the potential effects of SARS-CoV-2 pandemic on sexual lifestyle and epidemiology of sexually transmitted infections (STIs).1 In the study the author highlighted the importance to check the lasting effects of SARS-CoV-2 on STIs. As China is the first country to generally alleviate lockdown of most cities since beginning of April and the returns to usual lifestyle for nearly 6 months, we’re able to tract the epidemiology of STIs during the post-outbreak period in China.
According to the monthly report disclosed by Chinese Center for Disease Control and Prevention (Accessed from http://www.nhc.gov.cn/jkj/pqt/new_list.shtml), during the lockdown period of the first quarter, the number of newly diagnosed cases of HIV, syphilis and gonorrhea were 9695, 102273 and 16439, which reduced substantially by 27.3%, 19.3% and 38.2% compared to the previous year. After lockdown alleviation, the number of new cases returned, but not exceeding the previous years. The total new cases of HIV, syphilis and gonorrhea changed by -4.4%, -5.6% and -18.9% in the second quarter and -7.8%, -9.5% and +0.7% in the third quarter compared with 2019, respectively. As the number of new STIs in China is constantly growing in the past years, the reduction of new cases of STIs in 2020 after lockdown alleviation indicates a lasting effect of SARS-CoV-2. This may result from changes of sexual lifestyle or reduced hospital visits. More studies focusing on sex behaviors after lockdown alleviation are needed.
Reference：
1. Latini A, Magri F, Donà MG, et alIs COVID-19 affecting the epidemiology of STIs? The experience of syphilis in RomeSexually Transmitted Infections Published Online First: 27 July 2020. doi: 10.1136/sextrans-2020-054543
To the editor.
We read with interest an article by Ikeuchi et al.1 We agree with their conclusion that the relatively low dose of amoxicillin could lead to the cure of syphilis. However, we would like to raise concern that the findings might not be generalized to different populations. The majority of the patients had concurrent HIV infection, and the study setting is well known prestigious center for HIV care in Japan, with decades of HIV care in Tokyo, suggesting that the patients who participated in the study are likely to be adherent to the medications prescribed, because they are instructed thoroughly in taking antiretroviral therapy. In addition, those who did not have HIV infection in the study did not have a previous history of syphilis, and they might also be likely to be adherent to the regimen compared with those who had repeated STDs. As pointed out in the study, the recommended duration of amoxicillin therapy by Japanese STD guideline is very long (4-8 weeks), and we are not sure whether patients with syphilis in general can be adherent to this regimen. Therefore, we consider that the findings by Ikeuchi et al. may not be generalizable, particularly for those who are not very aware of the importance of adherence to the medication, or those who take the risk of STDs lightly (and have repeated STDs). Future studies with different settings and populations might clarify our concerns.
Reference
Show More1. Ikeuchi K, Fukushima K, Tanaka M, Yajima K, Im...
It would be good to have known the role of Mycoplasma genitalium in this population where asymptomatic infections by other pathogens were common and at least have mentioned it in the Discussion
Despite significant differences in testing opportunities, screening and access to care, this paper clearly sets out some important epidemiology of STIs accross Europe, particularly among MSM using PrEP. Despite this, there is no mention of sexually transmitted enteric infections, despite a recent outbreak of extensively drug resistant Shigella sonnei which has affected sexual networks of MSM accross Europe. There have been outbreaks of Shigella described in networks of MSM since the 1960s and can cause sugnificant morbidity. There are poor surveillance systems to monitor shigella outbreaks including transmssion of drug resistant organisms. More work is needed on both surveillance and shigella control strategies including awareness amongst both the communities affected and stakeholders including commissioners and public health.
The study by Dean et al. (1) on the treatment of PID was complicated and thought-provoking. Could it be that "mild" PID comprised many cases that were not PID at all? This issue bedevilled studies in the past, so why not here? Am I right in thinking that randomisation was used to try to maintain an evenness of disease severity between the two treatment arms, that is standard (SoC) with ofloxacin plus metronidazole, and an intervention arm (IA) with intramuscular ceftriaxone plus azithromycin and metronidazole? This is an important point when the outcome of each arm is to be compared. Presumably, after diagnosis treatment began without delay, not waiting for the results of microbiological tests which, in fact, showed M.genitalium in about 10% of cases in each arm, a proporttion seen by others (3) in acute PID. Standard treatment was judged to be slightly superior to the alternative treatment. Tests of microbiological cure 6 to 8 weeks after the study started showed a few azithromycin- resistant cases of M.genitalium, roughly comparable in the two arms. Not being aware of this at the start of treatment seems excusable. The reader must also realize that it was a situation experienced up to 9 years ago before an abrupt termination of the study. Today the scene is different, resistance of M.genitalium to azithromycin and other antibiotics being common (4). It has become clear that M.genitalium should be sought early followed rapidly by treatment guided by nothing othe...
Show MoreDear editor,
Show MoreWe thank Dr. Latini et al. for providing the data for the potential effects of SARS-CoV-2 pandemic on sexual lifestyle and epidemiology of sexually transmitted infections (STIs).1 In the study the author highlighted the importance to check the lasting effects of SARS-CoV-2 on STIs. As China is the first country to generally alleviate lockdown of most cities since beginning of April and the returns to usual lifestyle for nearly 6 months, we’re able to tract the epidemiology of STIs during the post-outbreak period in China.
According to the monthly report disclosed by Chinese Center for Disease Control and Prevention (Accessed from http://www.nhc.gov.cn/jkj/pqt/new_list.shtml), during the lockdown period of the first quarter, the number of newly diagnosed cases of HIV, syphilis and gonorrhea were 9695, 102273 and 16439, which reduced substantially by 27.3%, 19.3% and 38.2% compared to the previous year. After lockdown alleviation, the number of new cases returned, but not exceeding the previous years. The total new cases of HIV, syphilis and gonorrhea changed by -4.4%, -5.6% and -18.9% in the second quarter and -7.8%, -9.5% and +0.7% in the third quarter compared with 2019, respectively. As the number of new STIs in China is constantly growing in the past years, the reduction of new cases of STIs in 2020 after lockdown alleviation indicates a lasting effect of SARS-CoV-2. This may result from...