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An Ulcer by Any Other Name
The myriad presentations of ulcerative sexually transmitted infections, other than genital herpes and syphilis, challenge even the most astute clinician given the considerable overlap in clinical presentation and lack of widely available diagnostic resources, such as nucleic acid testing, to confirm the diagnosis. Even so, case prevalence is relatively low, and incidence of chancroid and granuloma inguinale are declining. These diseases still cause substantial morbidity and increased chance for HIV acquisition, and with the recent advent of mpox as a cause, it remains imperative to identify and treat accurately. (Source: I...
Source: Infectious Diseases Clinics of North America - March 31, 2023 Category: Infectious Diseases Authors: Ronnie M. Gravett, Jeanne Marrazzo Source Type: research

Syphilis
is an important public health problem in the U.S. and many high-income nations. The rates of syphilis continue to increase and there is an urgent need for medical providers of a variety of backgrounds to recognize this disease. In this review, we cover the key clinical findings of syphilis and provide an overview of the diagnosis and management of this disease in adults. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - March 31, 2023 Category: Infectious Diseases Authors: Meena S. Ramchandani, Chase A. Cannon, Christina M. Marra Source Type: research

Update on the Epidemiology, Screening, and Management of Chlamydia trachomatis Infection
This article provides an update on the epidemiology, natural history, and clinical manifestations of chlamyd ia in adults and discusses the current approaches to its management and control policy. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - March 31, 2023 Category: Infectious Diseases Authors: Jane S. Hocking, William M. Geisler, Fabian Y.S. Kong Source Type: research

Preface
It has been over 20 years since the Institute of Medicine published the landmark report entitled “The Hidden Epidemic: Confronting Sexually Transmitted Diseases.” The committee concluded that four major strategies should form the public and private sector response to what was then recognized as the growing (yet still hidden) epidemic of sexually transmitted infections (STIs): (1) overcome b arriers to adoption of healthy sexual behaviors; (2) develop strong leadership, strengthen investment, and improve information systems for STI prevention; (3) design and implement essential STI-related services in innovative ways fo...
Source: Infectious Diseases Clinics of North America - March 31, 2023 Category: Infectious Diseases Authors: Jeanne Marrazzo Source Type: research

COVID-19 Prevention in Solid Organ Transplant Recipients
Although COVID-19 vaccines are safe, most organ transplant recipients fail to mount an antibody response after two mRNA vaccines. Thus, three mRNA vaccines constitute a primary vaccine series after solid organ transplant. However, neutralizing antibodies after three or greater mRNA vaccines are lower against Omicron versus older variants. Predictors of attenuated responses include age, vaccination within 1 year from transplant, mycophenolate, and BNT162b2. Some seronegative transplant recipients exhibit durable T-cell responses. Vaccine effectiveness in transplants is lower than in the general population. Immunosuppression...
Source: Infectious Diseases Clinics of North America - March 21, 2023 Category: Infectious Diseases Authors: Maria Tsikala Vafea, Ghady Haidar Source Type: research

COVID-19 Prevention in Solid Organ Transplant Recipients: Current State of the Evidence
Although COVID-19 vaccines are safe, most organ transplant recipients fail to mount an antibody response after 2 mRNA vaccines. Thus, 3 mRNA vaccines constitute a primary vaccine series after SOT. However, neutralizing antibodies after 3 or greater mRNA vaccines are lower against Omicron versus older variants. Data for adenovirus vector vaccines are similar. Predictors of attenuated responses include age, vaccination within one year from transplant, mycophenolate, and BNT162b2. Some seronegative transplant recipients exhibit durable T-cell responses. Vaccine effectiveness in transplant is lower than the general population....
Source: Infectious Diseases Clinics of North America - March 21, 2023 Category: Infectious Diseases Authors: Maria Tsikala Vafea, Ghady Haidar Source Type: research

Coronavirus Disease 2019 Management Strategies in Solid Organ Transplant Recipients
Solid organ transplant recipients are at high risk of severe coronavirus disease-2019 (COVID-19). If left untreated, it results in high rates of hospitalization, intensive care unit admission and death. Early diagnosis of COVID-19 is essential to ensure the early administration of therapeutics. Treatment of mild-to-moderate COVID-19 with remdesivir, ritonavir-boosted nirmatrelvir, or an anti-spike neutralizing monoclonal antibody may prevent progression to severe and critical COVID-19. Among patients with severe and critical COVID-19, treatment with intravenous remdesivir and immunomodulation is recommended. This review ar...
Source: Infectious Diseases Clinics of North America - March 20, 2023 Category: Infectious Diseases Authors: Maria Alejandra Mendoza, Raymund R. Razonable Source Type: research

COVID-19 Management Strategies in Solid Organ Transplant Recipients
Solid organ transplant recipients are at high risk of severe coronavirus disease-2019. If left untreated, it results in high rates of hospitalization, intensive care unit admission and death. Early diagnosis of COVID-19 is essential to ensure the early administration of therapeutics. Treatment of mild to moderate COVID-19 with remdesivir, ritonavir-boosted nirmatrelvir or an anti-spike neutralizing monoclonal antibody may prevent progression to severe and critical COVID-19. Among patients with severe and critical COVID-19, treatment with intravenous remdesivir and immunomodulation is recommended. This review article discus...
Source: Infectious Diseases Clinics of North America - March 20, 2023 Category: Infectious Diseases Authors: Maria Alejandra Mendoza, Raymund Razonable Source Type: research

Advances in Diagnostics of Sexually Transmitted Infections
Sexually transmitted infections (STIs) are caused by various pathogens, many of which have common symptoms. Diagnostic tests are critical to supporting clinical evaluations in making patient management decisions. Molecular diagnostics are the preferred test type when available, especially in asymptomatic patients for many STIs. However, for some infections, serology offers the best insight into infectious status. Clinicians should be aware of the performance characteristics of the available STI diagnostic tests and understand how to use them. Point-of-care tests are helpful to implement rapid and accurate treatment respons...
Source: Infectious Diseases Clinics of North America - March 15, 2023 Category: Infectious Diseases Authors: Mauricio Kahn, Barbara Van Der Pol Source Type: research

Approach to Managing Sex Partners of People with Sexually Transmitted Infections
This article provides an overview of clinical recommendations regarding partner management, with particular emphasis on EPT, and an update on new and emerging evidence in the field. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - March 15, 2023 Category: Infectious Diseases Authors: Emily Hansman, Jeffrey D. Klausner Source Type: research

Outpatient Parenteral Antibiotic Therapy in Older Adults
Outpatient parenteral antimicrobial therapy (OPAT) for older adults is a complex process that involves multiple stakeholders and care coordination, but it is a useful and patient-centered tool with opportunities for the treatment of complicated infections, improved patient satisfaction, and reduced health-care costs. Older age should not be an exclusion for OPAT but rather prompt the OPAT provider to thoroughly evaluate candidacy and safety. Amid the on-going COVID-19 pandemic, innovations in OPAT are needed to shepherd OPAT care into a more patient-centered, thoughtful practice, whereas minimizing harm to older patients f...
Source: Infectious Diseases Clinics of North America - February 16, 2023 Category: Infectious Diseases Authors: Nora T. Oliver, Marion J. Skalweit Source Type: research

Considering Patient, Family, and Provider Goals and Expectations in a Rapidly Changing Clinical Context: A Framework for Antimicrobial Stewardship at the End of Life
Antibiotic administration is often a part of end-of-life (EOL) care, including among patients who are not critically ill. Guideline-issuing bodies recommend that antimicrobial stewardship providers (ASPs) provide support to prescribers making decisions about whether or not to treat infections in this population. Relatively little is known about the rationale for antimicrobial prescribing during the EOL period in noncritical care settings, although patient and family preferences are often an influencing factor. The effectiveness of antimicrobials in improving quantity or quality of life in this population is unclear and lik...
Source: Infectious Diseases Clinics of North America - February 16, 2023 Category: Infectious Diseases Authors: Jeffrey Larnard, Wendy Stead, Westyn Branch-Elliman Source Type: research

Acute and Chronic Infectious Prostatitis in Older Adults
Acute and chronic bacterial prostatitis are clinically significant entities that can be difficult to diagnose and appropriately treat. Herein, we review when to suspect these clinical conditions, how to diagnose them, and how to effectively treat them based on the extant literature. Our aim was to equip the practicing clinician with the ability to proficiently diagnose and manage acute and chronic bacterial prostatitis, particularly in older patients. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - February 16, 2023 Category: Infectious Diseases Authors: Tyler J. Brehm, Barbara W. Trautner, Prathit A. Kulkarni Source Type: research

Update on Clostridioides difficile Infection in Older Adults
Clostridioides difficile is a common cause of community-associated and health care-associated infections. Older adults are disproportionately affected, and long-term care facilities (LTCFs) have borne a substantial proportion of the burden of C difficile infection (CDI). Recurrences of CDI are common in older adults and have substantial adverse effects on quality of life. Appropriate diagnostic testing and management is essential for older adults in the community and in LTCFs. This review focuses on current concepts related to the epidemiology, diagnosis, and management of CDI in older adults. (Source: Infectious Diseases ...
Source: Infectious Diseases Clinics of North America - February 16, 2023 Category: Infectious Diseases Authors: Curtis J. Donskey Source Type: research

Sexually Transmitted Infections in Older Adults
Sexually transmitted infections (STIs) have been increasing in older adults. Sexual health remains an important part of overall health care at any age. There are several barriers and facilitators to addressing sexual health in this population. Changes attributable to normal physiologic aging as well as sexual dysfunction can affect sexuality in older adults. When it comes to preventing STIs, combination prevention strategies remain applicable in older adults. Addressing sexual health using a tailored approach is critical to stem the tide of increasing STIs rates in older adults. (Source: Infectious Diseases Clinics of North America)
Source: Infectious Diseases Clinics of North America - February 16, 2023 Category: Infectious Diseases Authors: Puja Van Epps, Lewis Musoke, Candice J. McNeil Source Type: research