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A survey of sexually transmitted diseases in five STD clinics in Papua New Guinea


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The first multicentre survey of sexually transmitted diseases (STDs) performed in Papua New Guinea was conducted in STD clinics in five towns, Port Moresby, Goroka, Rabaul, Lae and Daru, from September 1989 to May 1990. Infections with Neisseria gonorrhoeae and Chlamydia trachomatis (alone or in combination) were common. Penicillinase-producing N. gonorrhoeae (PPNG) represented 44% of all gonococcal isolates but significant intrinsic resistance to penicillin was not found. Of the other antibiotics tested, significant elevation of minimum inhibitory concentration (MIC) was common only for tetracycline, although no high-level tetracycline resistance was detected. C. trachomatis was detected by direct immunofluorescence (DIF) in 26% of 210 males and 27% of 64 females. 10% (21/210) of males and 11% (7/64) of females were both DIF positive for C. trachomatis and culture positive for N. gonorrhoeae. Of 203 males and 78 females tested, 5% and 12%, respectively, had serological evidence of current syphilis infection. Clinically, genital ulcer disease was most commonly due to syphilis, donovanosis or genital herpes, while specific vaginal infections were commonly seen in female patients attending Port Moresby and Lae STD clinics.
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... Gonorrhoea, caused by the Gram-negative coccoid bacterium Neisseria gonorrhoeae, remains one of the most common sexually transmitted infections (STIs) in Papua New Guinea (PNG) (1)(2)(3)(4). Rates have been steadily increasing over the last four decades (5) and the National Health Plan for 2001-2010 estimates the incidence rate for gonorrhoea to be 131 per 100,000 population (6). ...
... Rates have been steadily increasing over the last four decades (5) and the National Health Plan for 2001-2010 estimates the incidence rate for gonorrhoea to be 131 per 100,000 population (6). However, various studies have shown higher rates of gonococcal infection in selected populations within PNG and a survey of STI clinics reported that 54% of male attenders were clinically diagnosed with gonorrhoea (2). A high prevalence of gonococcal infection, detected by polymerase chain reaction (PCR), has also been reported among female sex workers in Port Moresby (34%), Lae (24%) and the Eastern Highlands Province (21%) (1,4). ...
... Similar to other studies in PNG (2,13,16,17), this study found that PPNG represented a large proportion (40%) of gonococcal isolates that cause disease in the community. PPNG are characteristically resistant to â-lactam antibiotics, because the penicillinase produced by PPNG hydrolyses the active component of â-lactam antibiotics, particularly penicillins (11,18). ...
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Antibiotic-resistant strains of Neisseria gonorrhoeae have the potential to undermine treatment and control of gonorrhoea, which remains a highly prevalent sexually transmitted infection (STI) in Papua New Guinea (PNG). The standard treatment regimen for gonorrhoea in PNG based on amoxycillin and clavulanic acid (amoxycillin-clavulanate) was introduced about 15 years ago and there is some concern that over time circulating strains may have developed resistance to this therapy. To investigate this, N. gonorrhoeae isolates (n = 52) were collected from STI clinics in geographically representative centres in PNG and tested for their in vitro susceptibility to a range of antibiotics. All 52 isolates tested were found susceptible to amoxycillin-clavulanate, despite 40% (n = 21) being penicillinase producers and thus resistant to penicillin. These findings indicate that amoxycillin-clavulanate therapy remains an effective treatment for gonococcal infections in PNG, and support the maintenance of the present standard treatment for gonorrhoea in PNG.
... Thus, it is quite possible that syphilis and yaws could exist in the same community. Several studies have reported the presence of syphilis in some countries where yaws is endemic (eg, Papua New Guinea), 46,47 and, in a number of countries of West Africa, high prevalence rates for syphilis have been found in pregnant women based on rapid treponemal tests. 48 In the past syphilis was generally considered to be more prevalent in large towns, where yaws is usually absent. ...
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Yaws, a neglected tropical disease, is targeted for eradication by 2020 through large-scale mass-treatment programs of endemic communities. A key determinant for the success of the eradication campaign is good understanding of the disease epidemiology. We did a review of historical trends and new information from endemic countries, with the aim of assessing the state of knowledge on yaws disease burden. Transmission of yaws is now present in Africa, Asia, and the South Pacific. At least 12 countries are known to harbor yaws cases and 21 to 42 million people live in endemic areas. Between 2008 and 2012 more than 300,000 new cases were reported to the World Health Organization. Yaws presented high geographical variation within a country or region, high seasonality for incidence of active disease, and evidence that low standards of hygiene predispose to suffering of the disease. Key data issues include low levels of reporting, potential misdiagnosis, and scarce documentation on prevalence of asymptomatic infections. Currently available data most likely underestimates the magnitude of the disease burden. More effort is needed in order to refine accuracy of data currently being reported. A better characterization of the epidemiology of yaws globally is likely to positively impact on planning and implementation of yaws eradication.
... Forty-seven (47) papers were excluded because they were not original research studies, meaning they did not report on the case number and sample size. Of these 15 papers, the majority (80%) were generated through the WHO WPR GASP [27][28][29][30][31][32][33][34][35][36][37][38], and 3 (20%) were from other surveillance [16,39,40]. resistance (n = 8), and, additionally, the small sample size used in the primary studies, these resulted in wide ninety-five percentage confidence intervals (95% CI) in this metaanalysis, see . ...
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Neisseria gonorrhoeae antimicrobial resistance (NG AMR) has become an urgent concern globally. The World Health Organization, the United States of America Centers for Disease Control, and other regulators have called to improve resistance-testing methods to enhance NG AMR surveillance. NG AMR surveillance remains critical in informing treatment; unfortunately, this is often lacking in settings with limited resources, such as Papua New Guinea (PNG). We conducted a systematic review and a prevalence meta-analysis, and provided an overview of NG AMR in PNG. We showed the lack of NG AMR data in the last decade, and emphasized the need for NG AMR surveillance in PNG. Since NG AMR testing by the NG culture method is unreliable in PNG, we suggested using molecular tests to complement and enhance NG AMR surveillance.
... The increasing mobility of persons makes this possibility more likely. Several studies have reported the presence of syphilis in some countries where yaws is endemic (e.g., Papua New Guinea) (306)(307)(308)(309)(310)(311), and it is unclear how the coexistence of venereal and nonvenereal transmission of treponemal infections might affect surveillance and assessment of eradication program success. This topic seems particularly relevant given the facts that patients in remote areas may not have access to sophisticated molecular techniques and that current serological tests are unable to discriminate among the agents of the human treponematoses. ...
SUMMARY The agents of human treponematoses include four closely related members of the genus Treponema: three subspecies of Treponema pallidum plus Treponema carateum. T. pallidum subsp. pallidum causes venereal syphilis, while T. pallidum subsp. pertenue, T. pallidum subsp. endemicum, and T. carateum are the agents of the endemic treponematoses yaws, bejel (or endemic syphilis), and pinta, respectively. All human treponematoses share remarkable similarities in pathogenesis and clinical manifestations, consistent with the high genetic and antigenic relatedness of their etiological agents. Distinctive features have been identified in terms of age of acquisition, most common mode of transmission, and capacity for invasion of the central nervous system and fetus, although the accuracy of these purported differences is debated among investigators and no biological basis for these differences has been identified to date. In 2012, the World Health Organization (WHO) officially set a goal for yaws eradication by 2020. This challenging but potentially feasible endeavor is favored by the adoption of oral azithromycin for mass treatment and the currently focused distribution of yaws and endemic treponematoses and has revived global interest in these fascinating diseases and their causative agents.
... The above search strategy resulted in 105 reports, including 25 studies that reported STI prevalence estimates (10 communitybased studies; 10 clinic-based studies; and 5 studies among female sex-workers (FSWs) recruited via community outreach), which were included in this review ( Figure 1; [26,27,29,33,39,45,46,47,48]; 2 on HSV-2 prevalence [49,50]; and 3 on bacterial vaginosis [37,38,43]. We were unable to identify laboratory-confirmed prevalence estimates for lymphogranuloma venereum or chancroid [51,52,53,54,55,56] and identified only one study reporting donovanosis (among 14/210 (6.7%) men and 5/64 (7.8%) women attending STI clinics in five urban centres [28]). No published or unpublished prevalence estimates among men that have sex with men (MSM) in PNG were identified in this systematic review. ...
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The potential for an expanded HIV epidemic in Papua New Guinea (PNG) demands an effective, evidence-based and locally-appropriate national response. As sexually transmitted infections (STIs) may be important co-factors in HIV transmission nationally, it is timely to conduct a systematic review of STI prevalences to inform national policy on sexual health and HIV/STI prevention. We undertook a systematic review and meta-analysis of HIV and STI prevalences in PNG, reported in peer-reviewed and non-peer-reviewed publications for the period 1950-2010. Prevalence estimates were stratified by study site (community or clinic-based), geographic area and socio-demographic characteristics. The search strategy identified 105 reports, of which 25 studies (10 community-based; 10 clinic-based; and 5 among self-identified female sex workers) reported STI prevalences and were included in the systematic review. High prevalences of chlamydia, gonorrhoea, syphilis and trichomonas were reported in all settings, particularly among female sex workers, where pooled estimates of 26.1%, 33.6%, 33.1% and 39.3% respectively were observed. Pooled HIV prevalence in community-based studies was 1.8% (95% CI:1.2-2.4) in men; 2.6% (95% CI:1.7-3.5) in women; and 11.8% (95% CI:5.8-17.7) among female sex workers. The epidemiology of STIs and HIV in PNG shows considerable heterogeneity by geographical setting and sexual risk group. Prevalences from community-based studies in PNG were higher than in many other countries in the Asia-Pacific. A renewed focus on national STI/HIV surveillance priorities and systems for routine and periodic data collection will be essential to building effective culturally-relevant behavioural and biomedical STI/HIV prevention programs in PNG.
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Thirty-seven strains of Neisseria gonorrhoeae isolated from several province of Cuba were studied; the plasmid profile was analysed in 37 isolates and minimal inhibitory concentration (MIC) was determined in 34 strains for several antimicrobial drugs (penicillin, tetracycline, spectinomycin, cefuroxime, ciprofloxacin, cefotaxime and ceftriaxone). The 65.63% were resistant to the penicillin (MIC ≥ 2μg/mL) and 59.37% to the tetracycline (MIC ≥ 2μg/mL). All the strains were sensitive to cephalosporins studied, spectinomycin and ciprofloxacin. Of the 32 strains 19 were PPNG (59.37%), 3 TRNG (9.38%) and only 1 showed chromosomal resistance to tetracycline. The plasmids of 3.2 Mda and 4.4 Mda were isolated from 15 and 4 strains respectively. In 3 strains was found the 25.2 Mda plasmid. The 24.5 Mda plasmid was significantly associated with the 3.2 Mda plasmid (p= 6,412 x 10 e-3), being predominant the 2.6/3.2/24.5 Mda plasmid profile (13 strains). In six strains (16.21%) was not possible find plasmids. A high incidence of strains with high level of resistance to penicillin was demonstrated. The determination of the plasmid profile constituted an useful tool in the characterization of strains of Neisseria gonorrhoeae, contributing to knowledge of the phenomenon of the antimicrobial resistance of strains circulating in Cuba.
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This book comes out of a much larger project of global ethnography conducted in Australia, Papua New Guinea, Malaysia, India, Sri Lanka, and elsewhere. It emphasizes the three major themes: community sustainability, community livelihoods, and community learning. Our overriding concern is to map the complex intersection, the tensions, both destructive and creative, of ontologically different formations as they work in and through each other in the contemporary globalizing world. The long-term objective of this ongoing project is to contribute broadly to social sustainability—culturally, politically, economically and ecologically. More particularly, here in Papua New Guinea, we focussed on ways of supporting and building the base-level foundations for enhancing the resilience and vibrancy of communities under threat. In effect, we wanted to rewrite the mainstream development literature by emphasizing the possibilities for revitalizing non-formal economies, restructuring health practices, and providing alternative pathways to community development through informal learning. One of the core strategies suggested by the research involves drawing on the existing strengths of communities, and working in partnership with government and civil-society organizations to create networks of community learning centres.
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Acute polyarthritis is an important cause of morbidity in many tropical countries. Classification has often been difficult, with the term tropical polyarthritis used for those in whom a diagnosis could not be made. The implication that this is a distinct entity is probably incorrect, with likely causes being septic arthritis or post-infective reactive arthritis. This study aimed to determine the types of arthritis found in 43 patients (30 men) presenting consecutively to the Goroka Base Hospital in the Eastern Highlands of Papua New Guinea. Gonococcal arthritis was diagnosed in eight patients (six men) on the basis of isolation of Neisseria gonorrhoeae from the joint aspirate. In all cases the N gonorrhoeae was identified by the closed culture system on chocolate agar, but not always by routine plating. There were no specific clinical features that identified patients with a gonococcal septic arthritis. The remaining 34 patients had an undifferentiated oligoarthritis. The pattern of arthritis in men and women was of a lower limb pauciarticular arthritis with a predilection for the knee and ankle joints. A total of 30% of male patients had a history of urethral discharge and 44% of all patients had preceding diarrhoea. Arthritis was the only feature in 59% of patients and in 32% there was an associated enthesitis. In this study most patients had an oligoarthritis consistent with a reactive arthritis or a septic arthritis due to N gonorrhoeae. Broth inoculation of synovial fluid was the best method to isolate N gonorrhoeae, with standard methods for gonococcal isolation failing in some patients. It is recommended that the term 'tropical polyarthritis' is no longer used as it does not refer to a specific entity but consists of several known arthritides.
Endocervical infections due to Chlamydia trachomatis remain difficult to diagnose due to the lack of an inexpensive, rapid, and accurate test. We evaluated an alternative strategy for diagnosis in which initial screening was performed with an enzyme immunoassay (Chlamydiazyme) followed by a direct fluorescent antibody (DFA) test on specimens in which the Chlamydiazyme optical density (OD) reading fell in an intermediate zone. Lowering the Chlamydiazme OD ratio (specimen to control) used to define a positive test from 1.0 (the ratio suggested by the manufacturer) to 0.3 raised the sensitivity of Chlamydiazyme from 73 to 83%. Confirmation of those specimens having OD ratios of 0.3 to 0.99 by DFA testing increased the specificity of Chlamydiazyme from 95 to 100%. This strategy necessitated performance of the DFA test on 5% of the specimens. Lowering the cutoff OD ratio below 0.3 increased the sensitivity even further but required DFA testing on greater than 25% of the specimens. Use of an adjusted positive cutoff value for defining positive enzyme immunoassays followed by DFA confirmation for intermediate-zone readings may be a feasible approach for some laboratories that lack cell culture facilities.
Chlamydia trachomatis is a human pathogen that causes ocular disease (trachoma and inclusion conjunctivitis), genital disease (cervicitis, urethritis, salpingitis, and lymphogranuloma venereum), and respiratory disease (infant pneumonitis). Respiratory chlamydioses also occur with infection by avian strains of C. psittaci or infection by the newly described TWAR agent. Diagnosis of most acute C. trachomatis infections relies on detection of the infecting agent by cell culture, fluorescent antibody, immunoassay, cytopathologic, or nucleic acid hybridization methods. Individual non-culture tests for C. trachomatis are less sensitive and specific than the best chlamydial cell culture system but offer the advantages of reduced technology and simple transport of clinical specimens. Currently available nonculture tests for C. trachomatis perform adequately as screening tests in populations in which the prevalence of infection is greater than 10%. A negative culture or nonculture test for C. trachomatis does not, however, exclude infection. The predictive value of a positive nonculture test may be unsatisfactory when populations of low infection prevalence are tested. Tests that detect antibody responses to chlamydial infection have limited utility in diagnosis of acute chlamydial infection because of the high prevalence of persistent antibody in healthy adults and the cross-reactivity due to infection by the highly prevalent C. trachomatis and TWAR agents. Assays for changes in antibody titer to the chlamydial genus antigen are used for the diagnosis of respiratory chlamydioses. A single serum sample that is negative for chlamydial antibody excludes the diagnosis of lymphogranuloma venereum.
Chlamydial infection in Papua New Guinea
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Decreased susceptibiliry ofNer'ssetia gonorthoeae to ciprofloxtan
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