[Sexually transmitted infections: a new hub&spoke model to control the increasing trend of STIs in Italy and prevent their spread].

The project "Experimentation of new integrated hospital-territory organizational models for the prevention and control of sexually transmitted infections: facilitated diagnostic-care pathways and offer of free targeted screening" was developed as part of the CCM 2019 programme, funded by the Italian Ministry of Health, being coordinated by the Italian National Health Institute (ISS), in collaboration with Sapienza University of Rome. Three clinical units located in Turin, Milan, and Cagliari, specialized in sexually transmitted infection (STI) diagnosis and treatment, and three highly specialized microbiology laboratories located in Trieste, Florence, and Palermo were involved.The objectives were to develop an innovative network model for the treatment of STIs based on multidisciplinary centres with high quality of care for STIs (hub-IST) and territorial structures (spoke-IST), to plan and test integrated facilitated care pathways for STIs, to evaluate the priorities, feasibility, and sustainability of prevention interventions.

Seven Years of Culture Collection of : Antimicrobial Resistance and Molecular Epidemiology.

The emergence of isolates displaying resistance to antimicrobials, in particular to ceftriaxone monotherapy or ceftriaxone plus azithromycin, represents a global public health concern. This study aimed to analyze the trend of antimicrobial resistance in a 7-year isolate collection retrospective analysis in Italy. Molecular typing on a subsample of gonococci was also included.

The Limitation of Accessing Hospital Services Due to COVID-19 Pandemic: A Pilot Study of the Telephone Triage to Re-Organize the Access to a Center for Sexual Health in Northwest Italy.

Background: The COVID-19 pandemic-related health crisis has imposed measures aimed at reducing the overcrowding of health facilities, by developing telemedicine and by forcing many sexually transmitted infection (STI) clinics to book appointments by telephone. In this work, we evaluate the performance of the nursing telephone triage system, introduced in the major STI center in Northwest Italy, for the adequacy of clinical pathways for of symptomatic STI patients.

Methods: From January to March 2021, all symptomatic patients wishing to access the CeMuSS center first underwent nurse-led telephone triage.

High-throughput nanopore sequencing of tandem repeat genes and reveals clade-specific patterns and recapitulates global whole genome phylogeny.

Sequencing of most genomes excludes repeat regions in and the gene, encoding the acidic repeat protein (). As a first step to understanding the evolution and function of these genes and the proteins they encode, we developed a protocol to nanopore sequence and genes from 212 clinical samples collected from ten countries on six continents. Both and repeat structures recapitulate the whole genome phylogeny, with subclade-specific patterns emerging.

Treponema pallidum genome sequencing from six continents reveals variability in vaccine candidate genes and dominance of Nichols clade strains in Madagascar.

In spite of its immutable susceptibility to penicillin, Treponema pallidum (T. pallidum) subsp. pallidum continues to cause millions of cases of syphilis each year worldwide, resulting in significant morbidity and mortality and underscoring the urgency of developing an effective vaccine to curtail the spread of the infection.

Estimation of Full-Length TprK Diversity in Treponema pallidum subsp. .

Immune evasion and disease progression of subsp. are associated with sequence diversity in the hypervariable outer membrane protein TprK. Previous attempts to study variation within TprK have sequenced at depths insufficient to fully appreciate the hypervariable nature of the protein, failed to establish linkage between the protein's seven variable regions, or were conducted on isolates passed through rabbits.

Low Tenofovir Plasma Exposure in HIV Oral Pre-exposure Prophylaxis Recipients with Gastrointestinal Disorders.

Four pre-exposure prophylaxis (PrEP) users with gastro-intestinal disorders (sleeve gastrectomy, terminal ileitis, celiac disease or chronic diarrhea) and receiving oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) were included. Despite a self-reported high adherence, trough plasma tenofovir concentrations (after a supervised intake) were significantly lower than those observed in PrEP recipients without gastrointestinal disorders [21 (±9.1) vs.

Enhanced Molecular Typing of Treponema pallidum subspecies pallidum Strains From 4 Italian Hospitals Shows Geographical Differences in Strain Type Heterogeneity, Widespread Resistance to Macrolides, and Lack of Mutations Associated With Doxycycline Resistance.

Background: Although syphilis rates have been relatively high in Italy for more than 15 years, no data on the molecular types of Treponema pallidum subspecies pallidum circulating in this country are yet available. Likewise, no data on how widespread is resistance to macrolide or tetracycline antibiotics in these strains exist. Such data would, however, promote comprehensive studies on the molecular epidemiology of syphilis infections in Italy and inform future interventions aiming at syphilis control in this and other European countries.

Time trend analysis (2009-2016) of antimicrobial susceptibility in Neisseria gonorrhoeae isolated in Italy following the introduction of the combined antimicrobial therapy.

Introduction: Neisseria gonorrhoeae (NG) antimicrobial susceptibility trends to azithromycin, cefixime and ceftriaxone were analyzed, from 2009 to 2016, to monitor changing antimicrobial susceptibility concomitant with the change in prescribing practice in 2012 from cefixime, or ceftriaxone, to ceftriaxone plus azithromycin. Patient characteristics predictive to be infected by antibiotic resistant N. gonorrhoeae were estimated.

Current treatments for anal condylomata acuminata.

Introduction: Condylomata acuminata are the most common sexually transmitted disease worldwide. They are not usually a serious problem, but it causes emotional distress to patient and physician alike because of its marked tendency to recurrence. The presence of anogenital warts mandates treatment, also for potential degeneration of the lesions.

Molecular characterization of Neisseria gonorrhoeae on non-cultured specimens from multiple anatomic sites.

Introduction: The aim of this study was to molecularly characterize Neisseria gonorrhoeae on non-cultured specimens collected from multiple anatomic sites. N. gonorrhoeae multiantigen sequence typing (NG-MAST) together with the gene sequence analysis of antimicrobial resistance (AMR) target genes were used.

Louseborne Relapsing Fever among East African Refugees, Italy, 2015.

During June 9-September 30, 2015, five cases of louseborne relapsing fever were identified in Turin, Italy. All 5 cases were in young refugees from Somalia, 2 of whom had lived in Italy since 2011. Our report seems to confirm the possibility of local transmission of louse-borne relapsing fever.

Evaluation of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) for identification and clustering of Neisseria gonorrhoeae.

Background: The sexually transmitted infection gonorrhea remains a public health concern for becoming resistant to drug treatments available. The purpose of this study was to evaluate the usefulness of the matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) to identify and cluster Neisseria gonorrhoeae. From a current monitoring in Italy, as part of the European Gonococcal Antimicrobial Surveillance Programme (EURO-GASP), 93 gonococci collected from 2007 to 2012 susceptible (44 isolates) and resistant (49 isolates) to cefixime were selected.

Changing antimicrobial resistance profiles among Neisseria gonorrhoeae isolates in Italy, 2003 to 2012.

The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobial agents is a major public health concern and a serious issue related to the occurrence of further untreatable gonorrhea infections. A retrospective analysis on 1,430 N. gonorrhoeae isolates, collected from 2003 through 2012, for antimicrobial susceptibility by Etest and molecular characterization by Neisseria gonorrhoeae multiantigen sequence typing (NG-MAST) was carried out in Italy.

Update on antimicrobial susceptibility and genotype of Neisseria gonorrhoeae isolated in Italy.

Antimicrobial susceptibilities and genotypes of Neisseria gonorrhoeae collected in 2006-2010 from 6 medical centers located in Italy were compared with those from a previous survey conducted in 2003-2005. Resistance to ciprofloxacin increased from 34.2% to 62% whereas penicillin resistance declined from 25.

Sexual behaviour reported by a sample of Italian MSM before and after HIV diagnosis.

In 2006 we conducted a cross-sectional study involving hospital clinical centres in five Italian cities to compare the sexual behaviour of HIV-positive MSM (men who have sex with men) before and after the diagnosis of HIV infection. Each centre was asked to enrol 30 HIV-positive persons aged ≥ 18 years. The questionnaire was administered to 143 MSM on average 9 years after HIV diagnosis.

Circulating levels of interleukin-17A and interleukin-23 are increased in patients with gonococcal infection.

Neisseria gonorrhoeae is the etiological agent of gonorrhoea, an infectious disease characterized by acute inflammation of the urogenital tract with a massive infiltration of neutrophils. Polymorphonuclear leukocyte recruitment is one of the activities of the recently described interleukin-17A (IL-17A); thus, we analyzed the serum concentration of IL-17A, together with IL-23 and interferon-γ (IFN-γ), in 27 patients with gonorrhoea. The concentration of these cytokines in patients' sera was significantly higher than that detected in healthy controls and an inverse correlation was found between the concentrations of IL-17A and IFN-γ.

Trend of ciprofloxacin resistance in Neisseria gonorrhoeae strains isolated in Italy and analysis of the molecular determinants.

A total of 599 Neisseria gonorrhoeae strains collected in Italy in 2 periods, 2003 to 2005 and 2007 to 2008, were screened for ciprofloxacin susceptibility by Etest. Ciprofloxacin-resistant strains (49.7%) were characterized by i) serovar determination, patterns of mutation in gyrA, and parC genes (38%, randomly selected) and ii) N.

Changes in at-risk behavior for HIV infection among HIV-positive persons in Italy.

Many HIV-positive persons reportedly continue to engage in at-risk behavior. We compared the sexual and drug-using practices of HIV-positive persons before and after the diagnosis of HIV infection to determine whether their behavior had changed. To this end, in 2006, we conducted a cross-sectional study involving clinical centers in five Italian cities.

Infective endocarditis in drug addicts: role of HIV infection and the diagnostic accuracy of Duke criteria.

Background: Intravenous drug users (IVDUs) are at increased risk of infective endocarditis. Moreover, HIV infection is common in IVDUs, with a reported prevalence of 40-90%. The clinical features of IVDUs with infective endocarditis and HIV infection may be peculiar.

Disseminated gonococcal infection in an immunocompetent patient caused by an imported Neisseria gonorrhoeae multidrug-resistant strain.

We herein report the microbiological features of a Neisseria gonorrhoeae strain isolated from an immunocompetent patient with disseminated gonococcal infection (DGI). The strain expressed the IA/IB serovar; was resistant to penicillin, tetracycline, and ciprofloxacin; and had presumably been acquired in Southeast Asia. To date, this is the first case reported in our country of DGI due to an imported multidrug-resistant strain.

A clinical approach for cardiovascular monitoring of HIV-infected patients. Results from an observational cohort study.

Background: HIV infection is one of the leading causes of acquired heart disease. Because of its high diffusion, systematic echocardiographic monitoring has been proposed to exclude cardiovascular involvement in these patients. The aim of this study was to evaluate an alternative clinical approach by which echocardiographic screening is limited to patients with a clinical suspicion of heart disease.