International travel and sexually transmitted disease.To the Editor: Recent articles in the professional literature (1-3) have offered advice regarding the importance of taking a careful travel history, particularly in this time of unprecedented levels of international travel (4). Such screening serves an important public health purpose as well, especially for sexually transmitted disease sexually transmitted disease (STD) or venereal disease, term for infections acquired mainly through sexual contact. Five diseases were traditionally known as venereal diseases: gonorrhea, syphilis, and the less common granuloma inguinale, (STD (Subscriber Trunk Dialing) Long distance dialing outside of the U.S. that does not require operator intervention. STD prefix codes are required and billing is based on call units, which are a fixed amount of money in the currency of that country. ) control. Sexual behaviors associated with travel can change the level of risks for STD transmission (5-7), and the epidemiology of STDs is not uniform throughout the world (8,9). These geographic differences may increase the risk of a traveler's becoming infected, or, conversely, increase the risk of a traveler's introducing a sexually transmitted pathogen, possibly one that is resistant to treatment, into a low-incidence area (10). In addition, different strains of pathogens may be common in different parts of the world (11-14). For example, quinolone-resistant Neisseria gonorrhoeae Neisseria gon·or·rhoe·ae n. Gonococcus. Neisseria gonorrhoeae The bacterium that causes gonorrhea. It cannot survive for any length of time outside the human body. (QRNG) is much more common in Asia (up to 40% of all isolates) (15). These strains of QRNG were first introduced in the United States by persons who engaged in sexual activity abroad, but now California and Hawaii have an increasing incidence of infection attributable to these strains (16). Indeed, QRNG has become endemic in those states, and incidence is no longer related to travel. During 1999-2001, only 3 QRNG isolates (0.28%) were identified among the 1,066 gonococcal Gonococcal The bacteria Neisseria gonorrheae that causes gonorrhea, a sexually transmitted infection of the genitals and urinary tract. The gonococcal organism may occasionally affect the eye, causing blindness if not treated. Mentioned in: Conjunctivitis isolates cultured in the STD Laboratory, State Laboratory Institute, Massachusetts Department of Public Health The Massachusetts Department of Public Health is a governmental agency of the Commonwealth of Massachusetts with various responsibilities related to public health within that state. (Massachusetts Department of Public Health, unpub. data). However, in 2002, 9 (2.1%) of 425 isolates of Neisseria gonorrhoeae were quinolone resistant. None of the persons recently infected reported a history of travel outside of New England. Unfortunately, few had reliable information to identify their partner(s). Those partners who were identified were either not located or did not agree to speak with the disease intervention specialist. This experience with antimicrobial resistance of Neisseria gonorrhoeae should serve as a model for STD prevention planning and programming. It highlights the importance of retaining the laboratory capacity to monitor antimicrobial susceptibilities of bacterial STD isolates. Treatment protocols should be adjusted in light of the prevalence of resistant strains of sexually transmitted pathogens. In cases in which symptoms associated with a bacterial STD persist after what is usually considered appropriate treatment, clinicians should obtain cultures and perform susceptibility tests on isolates. Nucleic acid nucleic acid, any of a group of organic substances found in the chromosomes of living cells and viruses that play a central role in the storage and replication of hereditary information and in the expression of this information through protein synthesis. amplification technologies do not provide critical antibiotic susceptibility information. In this situation, the public health STD program or laboratory should be contacted for guidance. Determining the sensitivity pattern of the pathogen in an expeditious fashion will ensure that appropriate and timely therapy can be initiated for the infected patient as well as enable more effective follow-up and treatment to sexual contacts. Asking patients who seek treatment for a possible STD about their own and their partner's travel histories is important to broaden the differential diagnosis differential diagnosis n. Determination of which one of two or more diseases with similar symptoms is the one from which the patient is suffering. Also called differentiation. (17). The increase in population mixing facilitated by travel and Internet-generated contacts may be diminishing the importance of the focality of traditional STD epidemiology. Finally, STD prevention messages should be a part of the health advice offered to travelers (7,18,19). Acknowledgments We thank Alfred DeMaria and Ralph Timperi for their thoughtful reviews and comments regarding this material. Paul Etkind,* Sylvie Ratelle,* and Harvey George* * Massachusetts Department of Public Health, Jamaica Plain, Massachusetts, USA References (1.) Ryan ET, Wilson ME, Kain KC. Illness after international travel. N Engl J Med 2002;347:505-16. (2.) Ryan ET, Kain KC. Health advice and immunizations for travelers. N Engl J Med 2000;342:1716-25. (3.) Harry TC. Infectious syphilis and importance of travel history. Lancet 2002; 359:447-8. (4.) World Health Organization. The state of the world health. In: The world health report 1996: fighting disease, fostering development. Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. : The Organization: 1997. p. 1-62. (5.) Matteelli A, Carosi G. Sexually transmitted disease in travelers. Clin Infect Dis 2001;32:1063-7. (6.) Cabada MM, Echevarria JI, Seas CR, Navarte G, Samalvides F, Freedman D, el al. Sexual behavior of international travelers visiting Peru. Sex Transm Dis 2002;29:510-3. (7.) Bloor M, Thomas M, Hood K, Abdeni D, Goujon Noun 1. goujon - large catfish of central United States having a flattened head and projecting jaw flathead catfish, Pylodictus olivaris, shovelnose catfish, spoonbill catfish, mudcat C, Hausser D, et al. Differences in sexual risk behaviour between young men and women travelling abroad from the UK. Lancet 1998;352:1664-8. (8.) Gerbase AC, Rowley JT, Mertens TE. Global epidemiology of sexually transmitted diseases Sexually transmitted diseases Infections that are acquired and transmitted by sexual contact. Although virtually any infection may be transmitted during intimate contact, the term sexually transmitted disease is restricted to conditions that are largely . Lancet 1998;351(Suppl 3): 2-4. (9.) Wasserheit JN, Aral SO. The dynamic topology of sexually transmitted disease epidemics: implications tot prevention strategies. J Infect Dis 1996;174(Suppl 2):S201-13. (10.) Thompson MM, Najera R. Travel and the introduction of human immunodeficiency virus human immunodeficiency virus n. HIV. Human immunodeficiency virus (HIV) A transmissible retrovirus that causes AIDS in humans. type I non-B subtype (programming) subtype - If S is a subtype of T then an expression of type S may be used anywhere that one of type T can and an implicit type conversion will be applied to convert it to type T. genetic forms into western countries. Clin Infect Dis 2001;32:1732-7. (11.) World Health Organization/Global Program on AIDS. Global prevalence and incidence estimates of selected curable cur·a·ble adj. Capable of being cured or healed. sexually transmitted diseases: Overview and estimates. Geneva: The Organization; 1995. p. 1-26. (12.) Van Dyek E, Crabbe E, Neila N, Bogaerts J, Munyabikali JP, Ghys P, et al. Increasing persistence of Neisseria gonorrhoeae in west and central Africa. Consequence on therapy of gonococcal infection. Sex Transm Dis 1997;24:32-7. (13.) Tapsall JW, Phillips EA, Schultz TR, Thacker C. Quinolone-resistant Neisseria gonorrhoeae isolated in Sydney, Australia, 1991 to 1995. Sex Transm Dis 1996;23: 425-8. (14.) Lewis DA, Bond M, Butt KD, Smith CP, Shafi MS, Murphy SM. A one-year survey of gonococcal infection seen in the genitourinary medicine department of a London district general hospital. Int J STD AIDS 1999; 10:588-94. (15.) WHO Western Pacific Gonococeal Antimicrobial Surveillance Programme. Surveillance of antibiotic resistance antibiotic resistance, n the ability of certain strains of microorganisms to develop resistance to antibiotics. antibiotic resistance in Neisseria gonorrhoeae in the WHO Western Pacific Region, 2000. Commun Dis Intell 2001;25:274-6. (16.) Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. . Increases in fluoroquinolone-resistant Neisseria gonorrhoeae--Hawaii and California. MMWR MMWR Morbidity & Mortality Weekly Report Epidemiology A news bulletin published by the CDC, which provides epidemiologic data–eg, statistics on the incidence of AIDS, rabies, rubella, STDs and other communicable diseases, causes of mortality–eg, Morb Mortal Wkly Rep 2002;51:1041-4. (17.) Kingston M, Warren C. Carlin car·line or car·lin n. Scots A woman, especially an old one. [Middle English kerling, from Old Norse, from karl, man.] E. Tropical warts. Lancet 2001;358:808. (18.) Mulhall BP. Sexual behaviour in travellers. Lancet 1999;353:595-6. (19.) Abdullah AS, Hedley AJ, Fielding R. Sexual behaviour in travellers. Lancet 1999;353:595-6. Address for correspondence: Sylvie Ratelle, Bureau of Communicable Disease Control, Massachusetts Department of Public Health, 305 South Street, Jamaica Plain, MA 02130. USA; fax: 617-983-6925;. email: sylvie.ratelle. @state.ma.us |
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