Consensus by Chinese Expert Panel on Chlamydia trachomatis-Resistant and Chlamydia trachomatis-Persistent Infection

Chlamydia trachomatis （Ct） genital infection is the most common sexually transmitted disease （STD） in China and the US. The morbidity of Ct genital infection in China has increased from 32.48/100,000 in 2008 to 37.18/100,000 in 2015.[1] The major areas of Ct infections are concentrated in the Zhujiang Delta, Changjiang Delta, Minjiang Area, and West China. In these areas, the highest incidence of Ct infection reaches 615.99/100,000 citizens. In the US, there are 1,441,789 reported Ct, which include 627.2 females and 278.4 males per 100,000 population. It is now the most prevalent STD, with its rate increasing to 22% in males and 6% in females.[2] Ct genital infection can cause epididymitis, prostatitis, cervicitis, annexitis, infertility, and atopic pregnancy, which have been identified as the major public health problems.

2019 Chinese expert consensus statement on diagnosis and treatment of syphilis

Syphilis,caused by Treponema pallidum subsp pallidum(T.pallidum),is a chronic,systemic human disease transmitted through sexual contact.The incidence and prevalence of syphilis is still high in China.[1]To guide the prevention measures and management of this disease,we renew the guidelines on diagnosis and treatment of syphilis[Supplementary file,http://links.lww.com/CM9/A292].Manifestations and diagnosis of all stages of syphilis are presented in Table 1,and management in Table 2.

Relationship between the high frequency of 23S rRNA point mutations in Treponema pallidum and low serological response rate to azithromycin treatment in China

Objective Although azithromycin is effective against Treponema pallidum (T.pallidum),the causative agent of syphilis,recent reports indicate that the prevalence of azithromycin resistance in China is very high,which may result in the failure of treatment.In this study,we aimed to investigate the association between azithromycin resistance and therapeutic outcomes in early syphilis patients.Methods Between February 2010 and December 2014,patients aged 18-65 years with early syphilis were enrolled.T.pallidum DNA were extracted to test the presence of A2058G and A2059G mutations.Then,eligible patients were randomly assigned to receive oral azithromycin (0.5 g,once daily for 15 days) or intramuscular BPG (2.4 million units,once weekly for 3 weeks).All patients were followed up in 2 weeks and 3,6,9,and 12 months after treatment to collect demographic and clinical characteristics and laboratory results.The differences on serological response,serological failure and serofast rate were compared between the two groups by Chi-square test.Results Among the 187 T.pallidum-infected patients enrolled,172 (92.0%) cases had a mutation associated with azithromycin resistance (A2058G,153 cases;A2059G,19 cases).During the 5-year study period,the percentage of cases enrolled with these mutations steadily increased,from 90.9% in 2010 to 95.3% in 2014.Of the 172 patients presenting with these mutations,only 78 (45.3%;all benzathine penicillin G [BPG]-treated) obtained a serological response to treatment;32.6% and 22.1% of patients presented with serological failure and serofast results,respectively.For azithromycin-treated cases,66.3% and 33.7% had serological failure and serofast results,respectively,in contrast with 1.1% and 11.3% of BPG-treated cases.However,among the A2058G-and A2059G-negative patients,the serological response rates between the two treatment groups were similar.In multivariate analyses,patients with lower rapid plasma reagin (RPR) titers (RPR,≤ 1 ∶ 8;odds ratio [OR],0.23;95% confidence interval [CI],0.09-0.37) or who received azithromycin treatment (OR,121.50;95% CI,35.38-386.17) were more likely to display serological failure and serofast results.Conclusion This prospective study found that the 23S rRNA A2058G and A2059G point mutations in T.pallidum are currently circulating with high frequency in China,suggesting a correlation between the high prevalence of macrolide resistance and a lower serolo gical response rate to azithromycin treatment.

National Guidelines on Diagnosis and Treatment of Gonorrhea in China (2020)

Gonorrhea is one of the main sexually transmitted diseases in China.It mainly affects the genitourinary tract,and its clinical manifestations vary from asymptomatic to complicated types.The diagnosis of gonorrhea should be based on the patient's epidemiologicai history,clinical manifestations,and laboratory examination results.Treatment should be prompt and standardized and should involve the recommended treatment regimens.Patients should be appropriately followed up after treatment.The antimicrobial resistance of gonococcal isolates has become a severe problem of clinical concern.In order to provide technical guidance of the diagnosis and treatment of gonorrhea for health care workers,the authors developed the guidelines based on the version of 2014,which will be of important in the standardizing medical care of gonorrhea,and further facilitating control and prevention of the disease.

Toe Absence Related to Verrucous Carcinoma

Introduction:Verrucous carcinoma is a rare variant of squamous cell carcinoma.It generally grows exogenously and bone erosion is rare.Here we present a case of verrucous carcinoma on the foot with toe absence.Case presentation:A 64-year-old man presented with a 6-year history of a slowly growing exogenous hyperkeratotic verrucous lesion on the right fifth toe,which had been absent for 1year.Before the lesion appeared,he had undergone nail extraction on this toe.The culture of fungi and mycobacteria were negative.Three-dimensional computed tomography showed that the fifth toe of the right foot was absent.Histopathological examination showed that the lesion was exogenous and verrucous and exhibited moderate keratinocyte hyperplasia.Combined with clinical manifestation and histopathological examination,verrucous carcinoma is suggested.The lesion was surgically excised,and the patient was followed up for more than 6months without recurrence.Discussion:Verrucous carcinoma is an exophytic tumor with verrucous growth at the beginning,which can invade deep tissues and even cause limb mutilation.When encountering a patient with a wart-like plaque on the foot that responds poorly to conventional treatments,clinicians should maintain a high degree of clinical vigilance and a low threshold for biopsy.Conclusion:We observed a rare outcome of toe absence associated with verrucous carcinoma.Therefore,early diagnosis of verrucous carcinoma is very important.Surgical excision is an effective treatment at present.Extensive resection is usually required to avoid recurrence.