In case you missed them, here are our top 5 articles for the week of March 26, 2017.
This past week’s Top 5 articles focused on screenings for sexually transmitted infections such as chlamydia and gonorrhea and ocular syphilis and HIV in an effort to avoid missed diagnoses of these infections that leave many patients untreated. On a more positive note, the Agency for Healthcare Research and Quality recently released preliminary data showing that the incidence of healthcare-associated conditions declined from 2010 to 2015. Articles highlighting troubling reports of severe strep infections in the United States that resulted in amputations in those infected, and an increase in influenza B infections as the 2016-2017 flu season winds down, round out our top two articles for the week.
According to a recent National Survey of Family growth, almost 36% of women ages 15 to 44 years have reported engaging in rectal intercourse of their lifetime. As such, the Centers for Disease Control and Prevention is recommending that women who report engaging in this practice should have rectal screenings for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC). Unfortunately, these tests are often overlooked, resulting in many missed infections. These infections are common and there is the potential for CT/GC organisms to migrate from the rectum to the vagina. Perhaps more troubling is the fact that women who are infected with these two sexually transmitted infections (STIs) often do not have symptoms, and so, if they are not proactively tested, and thus treated, the infections could lead to pregnancy complications, chronic pelvic pain, or pelvic inflammatory disease.
In related articles, researchers found that even when individuals are treated for these infections, patients in certain populations may not receive adequate treatment. Indeed, one study found that adolescents who are infected with CT or GC may not be treated appropriately. In this study, the researchers found that “a significant proportion of adolescents who presented to the emergency department of a large urban hospital were overtreated and an even higher proportion were undertreated for GC/CT.” According to the research, adolescent females who were more likely to “suffer from the sequelae of GC/CT [were] more likely to be undertreated.” Another study found that although women who are forced to have sexual intercourse were no more likely to be diagnosed with CT or GC than women who were never coerced, those who were diagnosed with an STI were less likely to receive treatment compared with women who did not experience forced sex.
The introduction of rapid diagnostic testing in emergency departments has resulted in marked improvement regarding detection and treatment of these STIs; however, researchers from all of the studies are calling for additional research, as well as more communication among these populations on the risks of these STIs in order to improve testing and follow-up.
To read more about updates on chlamydia and gonorrhea, click here.
New research has revealed that incidence of ocular syphilis (OS) is increasing, at least in North Carolina. In addition, OS may be more common in patients who are coinfected with HIV over those who are not.
Study results showed that from 2014 to 2015 there was a 64% increase in reported cases of early latent syphilis infections in North Carolina. In addition, almost half of the cases of syphilis in the state are among individuals who are co-infected with HIV. Half of these cases also had OS. Those individuals who were infected with OS were older than those who weren't and had a higher viral load than those without infection. The Centers for Disease Control and Prevention (CDC) issued a clinical advisory in March 2016, urging US clinicians to, “be aware of ocular syphilis, screen for visual complaints in patients at risk for syphilis, and test all patients with syphilis for HIV if their status is unknown or has been negative.” In addition, all patients who present with syphilis, particularly OS, should be screened for HIV.
According to the CDC, OS can affect any structure of the eye, but is most commonly associated with posterior uveitis (inflammation of the back of the uvea and sometimes the retina or optic nerve) and panuveitis (inflammation of the whole uveal tract, retina, and vitreous fluid). The infection can lead to permanent blindness and can be associated with neurosyphilis at any stage of infection. A neurological exam is recommended for any patient “with positive syphilis serology and early syphilis without ocular symptoms [and] patients with syphilis and ocular complaints should receive immediate ophthalmologic evaluation.” In addition, the CDC guidelines state that, “a lumbar puncture with cerebrospinal fluid examination should be performed in patients with syphilis and ocular complaints, [and] Ocular syphilis should be managed according to treatment recommendations for neurosyphilis (Aqueous crystalline penicillin G IV or Procaine penicillin IM with Probenecid for 10-14 days).”
More about the relationship between ocular syphilis and HIV co-infection is available here.
Some good news covered this past week was that the latest data released from the Agency for Healthcare Research and Quality’s (AHRQ) “National Scorecard on Rates of Hospital-Acquired Conditions” showed a decline in hospital-acquired infections (HAIs) in the United States from 2010 to 2015. The report data showed a 26% decrease in hospital-acquired conditions (HACs), which include “adverse drug reactions, pressure ulcers, and catheter-associated urinary tract infections (CAUTIs).” In the case of CAUTIs, the Centers for Disease Control and Prevention notes that, “UTIs are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network,” and approximately 75% of those infections are associated with the use of a urinary catheter.
The decrease in HACs noted by the AHRQ report translates into a savings of approximately $28 billion in healthcare costs—including about $8.3 billion in 2015, alone—and, approximately 125,000 fewer patients dying from HACs from 2010 to 2015.
AHRQ states that these reductions may be the result of an increased focus on safety and “initiatives implemented by the Centers for Medicare & Medicaid Services (CMS), as well as the US Department of Health and Human Services (HHS) Partnership for Patients initiative, which provides financial incentives to healthcare facilities that successfully reduced the incidence of HACs.”
These results are promising in that they reveal the possibility of making strides in reducing incidence of “virtually all types of HACs simultaneously,” an objective dubbed by CMS and HHS leaders as, “achieving ‘Safety Across the Board.’” Safety programs developed by AHRQ “continue to enable and guide improvements in healthcare delivery,” and the agency has “substantially expanded its efforts in order to extend the success that hospitals have achieved to all health care settings.” More specifically, “AHRQ is actively targeting current challenges such as diagnostic error and antibiotic resistance and developing and disseminating evidence-based practices that will sustain national progress in making health care safer.”
Read more about the AHRQ report here.
Strep throat infections are practically a rite of passage for the average American child; however, news of serious streptococcal infections that have resulted in amputations on the infected individuals has been alarming. Although these cases were seen in otherwise healthy adults and not children, it does not make them any less concerning.
These cases highlight the fact that Group A Streptococcus—the bacteria responsible for strep throat, as well as some skin and soft tissue infections and sinusitis—can sometimes cause serious complications such as “necrotizing fasciitis (a rapidly progressive and destructive skin/soft tissue infection), bacteremia (bloodstream infection), meningitis (infection of lining of the brain) or brain abscess, and streptococcal toxic shock syndrome (shock with multi-organ failure).” These complications underscore the need for early diagnosis and prompt treatment of streptococcal infections. Rapid antigen detection tests are typically used to detect strep throat infections. If tests results are positive, no further testing is needed; however, in the case of a negative result accompanied by common symptoms, a throat culture is typically needed in order confirm the infection and avoid a missed infection. In children, particularly, “early diagnosis and treatment of strep throat will reduce the risk of complications and help prevent potential transmission to parents, household contacts, or others.” Antibiotic treatment can help reduce the possibility of strep throat complications in adults, even though these infections are considered self-limited in this population and usually resolve over time. Beta-lactam classes of antibiotics, such as penicillin, remain effective at treating these infections.
Common symptoms of strep throat include, “an abrupt onset of sore throat and can be accompanied by fever, abdominal pain, decreased appetite, swollen tonsils and lymph nodes, and a widespread rash.” As with most infections, ‘an ounce of prevention is worth a pound of cure’ and so hand washing and good personal hygiene go a long way in staying healthy and uninfected.
To read more on invasive strep infections, go here.
The 2016-2017 flu season is winding down in most parts of the country; however, the Centers for Disease Control and Prevention (CDC) has stated that they are expecting flu activity to continue well into spring, as a total of 36 states are still experiencing widespread flu activity, including Alabama and Oklahoma. Indeed, in Alabama, state law makers recently introduced a bill in the state senate that would require schools to provide parents with information on infectious diseases as well as flu symptoms and virus transmission, flu vaccination, and CDC immunization recommendations. This action comes on the heels of high influenza activity that resulted in a number of school closures.
In Oklahoma, 68 flu-related deaths have been reported so far, with the highest number of deaths reported in Tulsa County (18 deaths) and Oklahoma County (8 deaths). The majority of the deaths that have been reported in the state were adults age 65 and older.
Because of the steady flu activity, “health officials are still offering flu vaccination to anyone age 6 months or older.” According to a new study out of the Perelman School of Medicine at the University of Pennsylvania, doctors may be able to increase influenza vaccination for the remainder of this year and years to come through a technique called, “active choice,” which includes “notifying patients of their eligibility for the flu vaccine and prompting them to accept or decline a vaccination order.” The study results showed that by using this method, “health care providers showed a 6% increase over clinics that did not use the alert system, and a 37% relative increase in vaccinations from the prior year.”
Influenza A (H3N2) was the predominant strain of the influenza virus this season, accounting for “79% of all flu-positive respiratory specimens”; however, the country has been seeing an increase in infections with the influenza B strain at this late stage in the season. According the CDC’s March 18, 2017 FluView report, of the specimens that were collected during that time period, 53% were positive for influenza A, while almost 47% were positive for influenza B.
Read more about the rise of influenza B infections here.