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Article ; Online: Prospective cohort study of treatment outcomes of vaginal discharge syndrome in women in Windhoek, Namibia.

Dunaiski, Cara M / Kock, Marleen M / Jung, Hyunsul / Peters, Remco P H

2024

Abstract: Background: Syndromic treatment is the standard of care for vaginal discharge syndrome (VDS) in resource-constrained settings. However, the outcomes of VDS treatment have not been well documented. This study aimed to determine the incidence, risk ... ...

Abstract	Background: Syndromic treatment is the standard of care for vaginal discharge syndrome (VDS) in resource-constrained settings. However, the outcomes of VDS treatment have not been well documented. This study aimed to determine the incidence, risk factors, and microbial etiology of treatment failure in women with VDS. Methods: This prospective cohort study of women with VDS was conducted between September 2021 and March 2022 at Katutura Intermediate Hospital in Windhoek, Namibia. Microbiological analyses of sexually transmitted infections (STI) (Chlamydia trachomatis; Neisseria gonorrhoeae; Trichomonas vaginalis; Mycoplasma genitalium), bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC) were performed. Treatment outcomes were assessed at 7 and 30 days after treatment, followed by microbial investigation in case of treatment failure. Results: One hundred and nine women were enrolled and 94 (86%) completed the follow-up. At baseline, 37/109 (40%) women were diagnosed with STI, 47/109 (43%) with BV and 45/109 (41%) with VVC. Candida albicans (33/45; 73%) was the main pathogen in VVC, with fluconazole resistance detected in 8/33 (24%) isolates; 10/12 (80%) of non-albicans Candida species showed resistance. The incidence of treatment failure was 3.6 per 100 person-years at 7 days and 1.0 per 100 person-years at 30 days follow-up; 17/94 (18%) women had recurrent VDS and 12/94 (13%) women had persistent VDS. VVC (OR 4.3; 95% CI 1.7-11, p = 0.002) at baseline was associated with treatment failure. Conclusions: Treatment failure after syndromic management of VDS is common in resource-constrained settings. Access to diagnostic testing, including fungal culture and susceptibility testing, is recommended to improve outcomes.
Language	English
Publishing date	2024-02-19
Publishing country	United States
Document type	Journal Article
ZDB-ID	435191-5
ISSN	1537-4521 ; 0148-5717
ISSN (online)	1537-4521
ISSN	0148-5717
DOI	10.1097/OLQ.0000000000001953
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Article ; Online: Antimicrobial effects of Medicines for Malaria Venture Pathogen Box compounds on strains of

Mensah, Eric / Fourie, P Bernard / Peters, Remco P H

Antimicrobial agents and chemotherapy

2023 Volume 67, Issue 11, Page(s) e0034823

Abstract: Therapeutic options ... ...

Abstract	Therapeutic options for
MeSH term(s)	Humans ; Neisseria gonorrhoeae ; Anti-Bacterial Agents/pharmacology ; Anti-Bacterial Agents/therapeutic use ; Gonorrhea/drug therapy ; Ceftriaxone/pharmacology ; Anti-Infective Agents/pharmacology ; Microbial Sensitivity Tests
Chemical Substances	Anti-Bacterial Agents ; Ceftriaxone (75J73V1629) ; Anti-Infective Agents
Language	English
Publishing date	2023-10-04
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	217602-6
ISSN	1098-6596 ; 0066-4804
ISSN (online)	1098-6596
ISSN	0066-4804
DOI	10.1128/aac.00348-23
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Article ; Online: Molecular epidemiology and antimicrobial resistance of vaginal Candida glabrata isolates in Namibia.

Dunaiski, Cara M / Kock, Marleen M / Chan, Wai Yin / Ismail, Arshad / Peters, Remco P H

Medical mycology

2024 Volume 62, Issue 2

Abstract: Candida glabrata is the most common non-albicans Candida species that causes vulvovaginal candidiasis (VVC). Given the intrinsically low susceptibility of C. glabrata to azole drugs, investigations into C. glabrata prevalence, fungal susceptibility ... ...

Abstract	Candida glabrata is the most common non-albicans Candida species that causes vulvovaginal candidiasis (VVC). Given the intrinsically low susceptibility of C. glabrata to azole drugs, investigations into C. glabrata prevalence, fungal susceptibility profile, and molecular epidemiology are necessary to optimise the treatment of VVC. This molecular epidemiological study was conducted to determine antifungal drug profile, single nucleotide polymorphisms (SNPs) associated with phenotypic antifungal resistance and epidemic diversity of C. glabrata isolates from women with VVC in Namibia. Candida glabrata isolates were identified using phenotypic and molecular methods. Antifungal susceptibility of strains was determined for fluconazole, itraconazole, amphotericin B, and anidulafungin. Whole genome sequencing was used to determine SNPs in antifungal resistance genes and sequence type (ST) allocation. Among C. glabrata isolates, all (20/20; 100%) exhibited phenotypic resistance to the azole class antifungal drug, (fluconazole), and phenotypic susceptibility to the polyene class (amphotericin B), and the echinocandins (anidulafungin). Non-synonymous SNPs were identified in antifungal resistance genes of all fluconazole-resistant C. glabrata isolates including ERG6 (15%), ERG7 (15%), CgCDR1 (25%), CgPDR1 (60%), SNQ2 (10%), FKS1 (5.0%), FKS2 (5.0%), CgFPS1 (5.0%), and MSH2 (15%). ST15 (n = 8/20, 40%) was predominant. This study provides important insight into phenotypic and genotypic antifungal resistance across C. glabrata isolates from women with VVC in Namibia. In this study, azole resistance is determined by an extensive range of SNPs, while the observed polyene and echinocandin resistance-associated SNPs despite phenotypic susceptibility require further investigation.
MeSH term(s)	Female ; Humans ; Antifungal Agents/pharmacology ; Candida glabrata ; Candidiasis, Vulvovaginal/microbiology ; Candidiasis, Vulvovaginal/veterinary ; Fluconazole ; Amphotericin B ; Anti-Bacterial Agents ; Anidulafungin ; Molecular Epidemiology ; Namibia/epidemiology ; Microbial Sensitivity Tests/veterinary ; Drug Resistance, Bacterial ; Echinocandins ; Azoles ; Polyenes ; Drug Resistance, Fungal/genetics
Chemical Substances	Antifungal Agents ; Fluconazole (8VZV102JFY) ; Amphotericin B (7XU7A7DROE) ; Anti-Bacterial Agents ; Anidulafungin (9HLM53094I) ; Echinocandins ; Azoles ; Polyenes
Language	English
Publishing date	2024-02-02
Publishing country	England
Document type	Journal Article
ZDB-ID	1421796-x
ISSN	1460-2709 ; 1369-3786
ISSN (online)	1460-2709
ISSN	1369-3786
DOI	10.1093/mmy/myae009
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Article ; Online: Performing

Peters, Remco P H / Mdingi, Mandisa M / Gigi, Ranjana M S / Lim, Lindsay / Medina-Marino, Andrew / Klausner, Jeffrey D / Muzny, Christina A

Sexually transmitted infections

2024 Volume 100, Issue 3, Page(s) 195–196

MeSH term(s)	Humans ; Female ; Trichomonas vaginalis ; Trichomonas Infections/diagnosis ; Trichomonas Vaginitis/diagnosis
Language	English
Publishing date	2024-04-18
Publishing country	England
Document type	Letter
ZDB-ID	1420303-0
ISSN	1472-3263 ; 1368-4973
ISSN (online)	1472-3263
ISSN	1368-4973
DOI	10.1136/sextrans-2024-056122
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Article ; Online: In vitro

Nyazema, Kudzai B / Shey, Bong-Akee / Sei, Clara J / Peters, Remco P H / Maningi, Nontuthuko E / Fischer, Gerald W / Bernard Fourie, P

Journal of clinical tuberculosis and other mycobacterial diseases

2024 Volume 35, Page(s) 100435

Abstract: Antimicrobial resistance alongside other challenges in tuberculosis (TB) therapeutics have stirred renewed interest in host-directed interventions, including the role of antibodies as adjunct therapeutic agents. This study assessed the binding efficacy ... ...

Abstract	Antimicrobial resistance alongside other challenges in tuberculosis (TB) therapeutics have stirred renewed interest in host-directed interventions, including the role of antibodies as adjunct therapeutic agents. This study assessed the binding efficacy of two novel IgG1 opsonic monoclonal antibodies (MABs; GG9 & JG7) at 5, 10, and 25 µg/mL to live cultures of
Language	English
Publishing date	2024-04-01
Publishing country	England
Document type	Journal Article
ISSN	2405-5794
ISSN (online)	2405-5794
DOI	10.1016/j.jctube.2024.100435
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Article ; Online: Importance of Candida infection and fluconazole resistance in women with vaginal discharge syndrome in Namibia.

Dunaiski, Cara M / Kock, Marleen M / Jung, Hyunsul / Peters, Remco P H

Antimicrobial resistance and infection control

2022 Volume 11, Issue 1, Page(s) 104

Abstract: Background: Vaginal discharge syndrome (VDS) is a common condition. Clinical management targets sexually transmitted infections (STIs) and bacterial vaginosis (BV); there is limited focus on Candida infection as cause of VDS. Lack of Candida treatment ... ...

Abstract	Background: Vaginal discharge syndrome (VDS) is a common condition. Clinical management targets sexually transmitted infections (STIs) and bacterial vaginosis (BV); there is limited focus on Candida infection as cause of VDS. Lack of Candida treatment coverage and, if present, antifungal resistance may result in VDS treatment failure. This study aimed to determine the prevalence of Candida infection, antifungal resistance, and coinfections in Namibian women with VDS. Methods: A cross-sectional study was performed using 253 vaginal swabs from women with VDS in Namibia. Demographic data was collected, and phenotypic and molecular detection of Candida species was performed followed by fluconazole susceptibility testing of Candida isolates. BV was diagnosed using Nugent score microscopy; molecular detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis was performed. Results: Candida species was detected in 110/253 women (43%). Ninety women (36%) had Candida albicans and 24 (9.5%) had non-albicans Candida species. The non-albicans species detected were 19 (17%) Candida glabrata, 4.0 (3.5%) Candida krusei, and 1.0 (0.9%) Candida parapsilosis. Candida albicans were more frequently isolated in younger (p = 0.004) and pregnant women (p = 0.04) compared to non-albicans Candida species. Almost all (98%) Candida albicans isolates were susceptible to fluconazole while all non-albicans Candida species were fluconazole resistant. STIs were diagnosed in 92 women (36%): 30 (12%) with C. trachomatis, 11 (4.3%) N. gonorrhoeae, and 70 (28%) T. vaginalis; 98 (39%) women had BV. Candida infection alone was diagnosed in 30 women (12%), combined with STIs in 42 women (17%) and was concurrent with BV in 38 women (15%). Candida infection was more often detected in swabs from women without C. trachomatis detected (6.4% vs. 16%; OR 0.30; 95% CI 0.10-0.77, p = 0.006). Conclusions: The high prevalence of Candida infection, especially those due to non-albicans Candida species that are resistant to fluconazole, is a great concern in our setting and may lead to poor treatment outcomes. Access to microbiological testing for Candida species in the context of syndromic management is warranted.
MeSH term(s)	Antifungal Agents/pharmacology ; Antifungal Agents/therapeutic use ; Candida/genetics ; Candidiasis ; Cross-Sectional Studies ; Female ; Fluconazole/pharmacology ; Fluconazole/therapeutic use ; Humans ; Male ; Microbial Sensitivity Tests ; Namibia/epidemiology ; Neisseria gonorrhoeae ; Pregnancy ; Sexually Transmitted Diseases ; Vaginal Discharge/drug therapy ; Vaginal Discharge/epidemiology
Chemical Substances	Antifungal Agents ; Fluconazole (8VZV102JFY)
Language	English
Publishing date	2022-08-15
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2666706-X
ISSN	2047-2994 ; 2047-2994
ISSN (online)	2047-2994
ISSN	2047-2994
DOI	10.1186/s13756-022-01143-6
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Article ; Online: Estimating the global burden of sexually transmitted infections.

Peters, Remco P H / Chico, R Matthew / Rowley, Jane / Low, Nicola

The Lancet. Infectious diseases

2022 Volume 22, Issue 8, Page(s) 1112–1113

MeSH term(s)	Humans ; Sexually Transmitted Diseases/epidemiology ; Sexually Transmitted Diseases/prevention & control
Language	English
Publishing date	2022-07-21
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	2061641-7
ISSN	1474-4457 ; 1473-3099
ISSN (online)	1474-4457
ISSN	1473-3099
DOI	10.1016/S1473-3099(22)00415-7
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Zs.A 5743: Show issues

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Article: A Skills-Based HIV Serostatus Disclosure Intervention for Sexual Minority Men in South Africa: Protocol for Intervention Adaptation and a Pilot Randomized Controlled Trial.

Daniels, Joseph / Peters, Remco P H / Medina-Marino, Andrew / Bongo, Cikizwa / Stephenson, Rob

JMIR research protocols

2022 Volume 11, Issue 5, Page(s) e36845

Abstract: Background: Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. ... ...

Abstract	Background: Gay, bisexual, and other men who have sex with men (GBMSM) living with HIV have low antiretroviral treatment adherence in South Africa due to limited skills in managing disclosure and prevention behaviors with sexual and romantic partners. As a result, there is a high HIV transmission risk within HIV-discordant partnerships, but an existing intervention may address these outcomes, if adapted effectively. Healthy Relationships (HR) is a behavioral intervention that was originally delivered in groups and in person over 5 sessions to develop coping skills for managing HIV-related stress and sexually risky situations, enhance decision-making skills for HIV disclosure to partners, and establish and maintain safer sex practices with partners. HR effectively improves prevention behaviors but has yet to be tailored to a non-US context. Objective: We aim to adapt HR into a new culturally grounded intervention entitled Speaking Out & Allying Relationships for GBMSM and then assess its feasibility in Eastern Cape, South Africa. Methods: The study will have 2 aims. For aim 1-adaptation-we will use a human-centered design approach. Initial intervention tailoring will involve integrating Undetectable=Untransmittable and pre-exposure prophylaxis education, developing intervention content for a videoconference format, and designing role-plays and movies for skill building based on preliminary data. Afterward, interviews and surveys will be administered to GBMSM to assess intervention preferences, and a focus group will be conducted with health care providers and information technology experts to assess the intervention's design. Finally, a usability test will be performed to determine functionality and content understanding. Participants will be GBMSM living with HIV (n=15) who are in a relationship and health care providers and information technology (n=7) experts working in HIV care and programming with this population. For aim 2, we will examine the feasibility of the adapted intervention by using a pilot randomized control design. There will be 60 individuals per arm. Feasibility surveys and interviews will be conducted with the intervention arm, and behavioral and biomedical assessments for relationship and treatment adherence outcomes will be collected for both arms. All participants will be GBMSM living with HIV who are in a relationship with an HIV-negative or unknown status partner. Results: Intervention adaptation began in August 2021. Initial tailoring and the refining of GBMSM intervention preferences were completed in December 2021. Usability and feasibility assessments are due to be completed by March 2022 and February 2024, respectively. Conclusions: GBMSM need efficacious interventions that tackle partnership dynamics, HIV prevention, and treatment outcomes for antiretroviral treatment adherence and viral suppression in South Africa. Harnessing everyday technology use for social networking (eg, videoconferences), Undetectable=Untransmittable education, and pre-exposure prophylaxis to update an existing intervention for South African GBMSM has the potential to strengthen relationship communication about HIV treatment and prevention and, in turn, improve outcomes. International registered report identifier (irrid): DERR1-10.2196/36845.
Language	English
Publishing date	2022-05-16
Publishing country	Canada
Document type	Journal Article
ZDB-ID	2719222-2
ISSN	1929-0748
ISSN	1929-0748
DOI	10.2196/36845
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Article ; Online: Low prevalence of

Peters, Remco P H / Mdingi, Mandisa / Jung, Hyunsul / Mukomana, Freedom / Gigi, Ranjana M S / Medina-Marino, Andrew / Klausner, Jeffrey D

Southern African journal of infectious diseases

2023 Volume 38, Issue 1, Page(s) 521

Language	English
Publishing date	2023-06-15
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	3046282-4
ISSN	2313-1810 ; 2312-0053
ISSN (online)	2313-1810
ISSN	2312-0053
DOI	10.4102/sajid.v38i1.521
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Article ; Online: Doxycycline post-exposure prophylaxis for sexually transmitted infections in South Africa.

Peters, Remco P H / McIntyre, James A / Garrett, Nigel / Brink, Adrian J / Celum, Connie L / Bekker, Linda-Gail

Southern African journal of HIV medicine

2023 Volume 24, Issue 1, Page(s) 1510

Abstract: South Africa has a large burden of bacterial sexually transmitted infections (STIs) with high rates among men who have sex with men (MSM). Randomised controlled trials have recently demonstrated high effectiveness of doxycycline post-exposure prophylaxis ...

Abstract	South Africa has a large burden of bacterial sexually transmitted infections (STIs) with high rates among men who have sex with men (MSM). Randomised controlled trials have recently demonstrated high effectiveness of doxycycline post-exposure prophylaxis (PEP) for prevention of bacterial STIs in MSM, with 70% - 85% reductions in
Language	English
Publishing date	2023-09-28
Publishing country	South Africa
Document type	Journal Article
ZDB-ID	2259791-8
ISSN	2078-6751 ; 2078-6751
ISSN (online)	2078-6751
ISSN	2078-6751
DOI	10.4102/sajhivmed.v24i1.1510
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