无症状肛生殖器和咽隐性感染的自发清除：NABOGO 试验的二次分析。

Spontaneous clearance of asymptomatic anogenital and pharyngeal : a secondary analysis from the NABOGO trial.

机构信息

Department of Infectious Diseases, Public Health Service of Amsterdam, Amsterdam, The Netherlands.

Amsterdam UMC, University of Amsterdam, Department of Dermatology, Amsterdam institute for Infection and Immunity (AII), location Academic Medical Center, Amsterdam, the Netherlands.

出版信息

Sex Transm Infect. 2023 Jun;99(4):219-225. doi: 10.1136/sextrans-2022-055488. Epub 2022 Jul 12.

DOI:10.1136/sextrans-2022-055488

PMID:35820778

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10314023/

Abstract

INTRODUCTION

Spontaneous clearance of asymptomatic (NG) does occur, but data are scarce. We aimed to assess spontaneous clearance among patients with asymptomatic anal, pharyngeal, vaginal and urethral NG infections who participated in the New AntiBiotic treatment Options for uncomplicated GOnorrhoea (NABOGO) trial. In addition, we assessed the determinants associated with spontaneous clearance.

METHODS

The NABOGO trial (Trial registration number: NCT03294395) was a randomised controlled, double-blind, single-centre trial assessing non-inferiority of ertapenem, gentamicin and fosfomycin to ceftriaxone for treatment of uncomplicated gonorrhoea. For asymptomatic NABOGO participants, we collected pre-enrolment and enrolment visit samples before trial medication was given. Spontaneous clearance was defined as a positive pre-enrolment nucleic acid amplification test (NAAT) result, followed by a negative NAAT at enrolment. We compared the median time between pre-enrolment and enrolment visits for patients who cleared spontaneously and for those who did not. Determinants of spontaneous clearance were assessed using logistic regression.

RESULTS

Thirty-two of 221 (14.5%) anal NG infections cleared spontaneously, 17 of 91 (18.7%) pharyngeal, 3 of 13 (23.1%) vaginal and 9 of 28 (32.1%) urethral NG infections. The median time between the pre-enrolment and enrolment visit was longer for patients who cleared their pharyngeal infection spontaneously compared with those who did not (median 8 days (IQR=7-11) vs 6 days (IQR=4-8), p=0.012); no determinants of clearance at other sites were identified. Overall, patients with more days between the pre-enrolment and enrolment visit were more likely to clear spontaneously (adjusted OR=1.06 per additional day, 95% CI 1.01 to 1.12). No association between location of NG infection and spontaneous clearance was found.

CONCLUSIONS

A significant proportion of asymptomatic patients cleared their NG infections spontaneously. Given these results, treatment of all NG infections after a one-time NAAT may be excessive, and more research on the natural history of NG is needed to improve antibiotic stewardship.

摘要

引言

无症状（NG）的自然清除确实会发生，但数据很少。我们旨在评估参加新抗生素治疗非复杂性淋病选择（NABOGO）试验的无症状肛、咽、阴道和尿道 NG 感染患者的自然清除率。此外，我们评估了与自然清除相关的决定因素。

方法

NABOGO 试验（试验注册编号：NCT03294395）是一项随机对照、双盲、单中心试验，评估了厄他培南、庆大霉素和磷霉素与头孢曲松治疗非复杂性淋病的非劣效性。对于无症状的 NABOGO 参与者，我们在给予试验药物之前收集了入组前和入组时的样本。自然清除被定义为阳性入组前核酸扩增试验（NAAT）结果，随后在入组时为阴性 NAAT。我们比较了自发清除和未清除的患者从入组前到入组的中位时间。使用逻辑回归评估自然清除的决定因素。

结果

221 例肛 NG 感染中，32 例（14.5%）自发清除，91 例咽 NG 感染中，17 例（18.7%）自发清除，13 例阴道 NG 感染中，3 例（23.1%）自发清除，28 例尿道 NG 感染中，9 例（32.1%）自发清除。与未清除的患者相比，自发清除咽 NG 感染的患者从入组前到入组的中位时间更长（中位数 8 天（IQR=7-11）比 6 天（IQR=4-8），p=0.012）；未确定其他部位清除的决定因素。总体而言，入组前和入组之间的天数越多，自发清除的可能性越大（调整后的优势比=每增加一天 1.06，95%CI 1.01-1.12）。未发现 NG 感染部位与自然清除之间存在关联。