Gonorrhoea Infection Prevalence in Human Immunodeficiency Virus Positive Patients Based on Polymerase Chain Reaction Examination | Puspitosari | International Journal of Integrated Health Sciences 270 948 1 PB
Original Aricle
Gonorrhoea Infecion Prevalence in Human Immunodeiciency Virus Posiive
Paients Based on Polymerase Chain Reacion Examinaion
Diah Puspitosari,1 Asmaja Soedarwoto,2 Dendi Sandiono,2 Feilicia Henrica Teja,1 Rini Rasiani,1
Rasmia Rowawi,2 Rahmatdinata,2 Tony Djajakusumah2
Faculty of Medicine, Universitas Padjdajaran-Dr. Hasan Sadikin General Hospital
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjajaran-Dr. Hasan Sadikin General
Hospital
1
2
Abstract
Objecive: To determine the prevalence of gonorrhoea infecion in male
and female HIV posiive paients based on polymerase chain reacion (PCR)
examinaion at the Teratai Clinic, Dr. Hasan Sadikin General Hospital Bandung.
Methods: This study was conducted in July, 2012 at the Teratai Clinic, while
the PCR examinaion was performed at the Molecular Biology Laboratory
of Microbiology Department, Faculty of Medicine, Universitas Padjadjaran,
Bandung. This was a cross-secional observaional study. The subjects were 81
HIV posiive paients who were taken in consecuive admission. They underwent
history taking and physical examinaion. Samples were taken from urethral swab
in males and cervical swab in females for PCR examinaion.
Results: The PCR examinaion result was posiive for gonorrhea in 36% subjects.
From all male subjects paricipaing in the study, 37% were posiive while 33% of
the female subjects were also posiive for gonorrhea.
Received:
January 4, 2013
Revised:
April 7, 2013
Accepted:
April 10, 2014
Conclusions: The prevalence of gonorrhoea infecion in male and female HIV
posiive paients at the Teratai Clinic, Dr. Hasan Sadikin General Hospital
Bandung is quite high, i.e 37% and 33%, respecively.
Keywords: Gonorrhoea, human immunodeiciency virus, polymerase chain
reacion, prevalence
IJIHS. 2014;2(1):1–8
Introducion
Gonorrhea is the second most common sexually
transmited infecion (STI) in the United States
and it infects more than 700,000 people per
year with an equal raio between male and
female.1 It was stated by the United Naions
Joint Program on Human Immunodeiciency
Virus/Acquired Immunodeiciency Syndrome
(UNAIDS) that the gonorrhea prevalence in the
general populaion in Indonesia was 20 to 31%
in 2004.2 Meanwhile, data from 2007 Integrated
Biological and Behavioral Surveillance (IBBS) on
the prevalence of STIs in female sexual workers
(FSWs) in Indonesia show that the prevalence of
gonorrhea ranged between 16% and 44%, with
the highest incidence found in West Java.3
Correspondence:
Diah Puspitosari, Faculty of Medicine, Universitas
Padjadjaran-Dr. Hasan Sadikin General Hospital
Jl. Pasteur No. 38, Bandung, Indonesia
e-mail: diahpoppy@gmail.com
Established diagnosis of gonorrhea infecion
is made through Neisseria gonorrhoeae (N.
gonorrhoeae) ideniicaion in the genital tract,
rectal, pharyngeal, and ocular secreion, which
can be done using several methods, such as
microscopic examinaion, culture, and molecular
techniques.1,4–6 Polymerase chain reacion (PCR)
examinaion is one of the molecular techniques
with a higher sensiivity, from 90–100%, than
culture technique which has 68% sensiivity.4–7
This technique has been stated to replace the
culture technique, including for asymptomaic
paients.7
Human immunodeiciency virus (or referred
to as HIV) infecion causes an immunosuppressed
condiion that could increase the number of STIs
and lead to greater co-diagnosis condiion.8,9
People with acive STIs are more prone to HIV
infecion, and vice versa. HIV posiive paients
who are exposed to STIs also have a greater risk
to transmit HIV.9 Some epidemiological data
have suggested that gonorrhea contributes to
Internaional Journal of Integrated Health Sciences. 2014;2(1):1–8
1
Gonorrhoea Infecion Prevalence in Human Immunodeiciency Virus Posiive Paients Based on Polymerase
Chain Reacion Examinaion
increased HIV transmission.10 The frequency of
mucosal HIV increases by 32–41% in gonorrhea
paients and its transmission risk increases to
approximately 2–5 imes higher.11–14
Several factors that contribute to the increase
of HIV infecion are HIV-infected cell withdrawal
in the genital tract as a part of the immune
response and cluster of difereniaion, in this
case the CD4, lymphocyte simulaion that will
eventually lead to increased replicaion of HIV.12
From the immunology perspecive, the
presence of gonorrhea increases HIV shedding
on the genital tract which atracts CD4 T
lymphocytes as a part of the inlammatory
response against patogen.10,11,15 In addiion to
the viral sheddings, the fact that some people
with HIV and AIDS are sill engaged in some high
risk sexual behaviors becomes the key factor in
STI co-infecions, including gonorrhea, with HIV
and AIDS.16–20
Sexually transmited infecions in people with
HIV suggest the possibility that these people
may sill be engaged in risky sexual behaviors.
These infecions could be a risk factor for HIV
transmission to uninfected populaion.16 Other
studies also support this.9,17 Manning et al.18
revealed that high-risk sexual pracices sill
occur among some segments of HIV posiive
populaion. To decrease associated morbidity
and prevent the secondary spread of HIV and
STIs, prevenion eforts should focus on HIV
posiive paients who are sill engaged in highrisk sexual pracices.
Thus, data regarding gonorrhea infecion in
people with HIV are criical for the prevenion,
screening, and treatment of HIV to reduce HIV
transmission.16,19 However, unil recently, data on
STI prevalence, including data on asymptomaic
gonorrhea in individuals with HIV posiive, are
sill limited.3,10,21
Unil now, there are sill limited numbers
of publicaion available on the prevalence of
gonorrhea infecion among HIV posiive paients
in Indonesia; therefore this study aimed to
determine the prevalence of gonorrhea infecion
in male urethra and female cervix of HIV posiive
paients based on PCR examinaion results in
Teratai Clinic, Dr. Hasan Sadikin General Hospital,
Bandung.
Methods
This study is a cross-secional observaional study
performed to 81 HIV posiive paients who visited
Teratai Clinic, Dr. Hasan Sadikin General Hospital
Bandung, Indonesia. The subjects were taken
in consecuive admission in July 2012. The HIV
2
serostatus of the study populaion had already
been determined and conirmed based on the
procedures stated in the Naional Guideline for
HIV before the study. Sexually acive HIV posiive
paients atending Teratai Clinic were ofered to
paricipate in this study. Fourty eight males and
33 females were enrolled ater signing writen
informed consent. Women having her menstrual
period were excluded from the study.
The subjects underwent history taking and
physical examinaion. Sample was collected from
urethral swab in male and cervical swab in female
for PCR examinaion. Comprehensive data on
paient’s characterisics and sexual history were
obtained through history taking and medical
records. The history taking, clinical examinaion,
and specimens collecions were performed in
Teratai Clinic while the specimen processing was
conducted at the Biology Molecular Laboratory,
Microbiology Department, Faculty of Medicine,
Universitas Padjadjaran, Bandung.
The protocol of this study was reviewed
and approved by the Ethical Commitee of the
Faculty of Medicine of Universitas PadjadjaranDr. Hasan Sadikin General Hospital, Bandung.
Specimen collecion kits (Roche) was used for
urethral swab for male paients and endocervical
swab for female paients. Transport medium
tubes (Roche) were used for transporing the
specimens to the laboratory on the day of the
collecion. Immediately ater arrival at the
laboratory, the urethral and endocervical swab
specimens were prepared for the PCR assay as
instructed by the manufacturer, kept frozen at
-20 °C, and analyzed within 14 days of sampling.
Transport medium tubes were thoroughly mixed
and 100 mL was withdrawn and diluted to 1 mL
with sucrose-phosphate medium. Ater that, 1
mL of swab specimen diluent (F. Hofmann-La
Roche Ltd., Basel, Switzerland), was added and
the prepared specimens were frozen at -20 °C
for PCR.
The PCR assay was accomplished using Roche
CT/NG Amplicor PCR kit and the ampliicaion
process was conducted by using a thermocycler
machine. Roche CT/NG Amplicor PCR kit for N.
gonorrhoeae (Roche Moecular System, Inc.,
Brancburb, USA) is a qualitaive in vitro test for the
detecion of N. gonorrhoeae DNA in urine from
symptomaic and asymptomaic males and in
endocervical swab specimen from symptomaic
and asymptomaic females as evidence of N.
gonorrhoeae infecion. N. gonorrhoeae DNA
is detected by PCR ampliicaion of target DNA
and by hybridizaion capture of ampliied
target. Ater the ampliicaion, the ampliied
nucleoide sequences were detected using an
enzyme immunoassay and the A450s were then
Internaional Journal of Integrated Health Sciences. 2014;2(1):1–8
Diah Puspitosari, Asmaja Soedarwoto, et al.
measured with a spectrophotometer (Muliskan;
Labsystems Ltd., Findland).
As stated in the Operator’s Manual for the
Amplicor Analyzer, the results were seen in the
print out for the lags. Interpretaion of the results
is as follow: posiive result for N. gonorrhoeae
is conirmed if the value of the examinaion
materials >3.5 and a negaive result is conirmed
if the value of the examinaion materials
Gonorrhoea Infecion Prevalence in Human Immunodeiciency Virus Posiive
Paients Based on Polymerase Chain Reacion Examinaion
Diah Puspitosari,1 Asmaja Soedarwoto,2 Dendi Sandiono,2 Feilicia Henrica Teja,1 Rini Rasiani,1
Rasmia Rowawi,2 Rahmatdinata,2 Tony Djajakusumah2
Faculty of Medicine, Universitas Padjdajaran-Dr. Hasan Sadikin General Hospital
Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjajaran-Dr. Hasan Sadikin General
Hospital
1
2
Abstract
Objecive: To determine the prevalence of gonorrhoea infecion in male
and female HIV posiive paients based on polymerase chain reacion (PCR)
examinaion at the Teratai Clinic, Dr. Hasan Sadikin General Hospital Bandung.
Methods: This study was conducted in July, 2012 at the Teratai Clinic, while
the PCR examinaion was performed at the Molecular Biology Laboratory
of Microbiology Department, Faculty of Medicine, Universitas Padjadjaran,
Bandung. This was a cross-secional observaional study. The subjects were 81
HIV posiive paients who were taken in consecuive admission. They underwent
history taking and physical examinaion. Samples were taken from urethral swab
in males and cervical swab in females for PCR examinaion.
Results: The PCR examinaion result was posiive for gonorrhea in 36% subjects.
From all male subjects paricipaing in the study, 37% were posiive while 33% of
the female subjects were also posiive for gonorrhea.
Received:
January 4, 2013
Revised:
April 7, 2013
Accepted:
April 10, 2014
Conclusions: The prevalence of gonorrhoea infecion in male and female HIV
posiive paients at the Teratai Clinic, Dr. Hasan Sadikin General Hospital
Bandung is quite high, i.e 37% and 33%, respecively.
Keywords: Gonorrhoea, human immunodeiciency virus, polymerase chain
reacion, prevalence
IJIHS. 2014;2(1):1–8
Introducion
Gonorrhea is the second most common sexually
transmited infecion (STI) in the United States
and it infects more than 700,000 people per
year with an equal raio between male and
female.1 It was stated by the United Naions
Joint Program on Human Immunodeiciency
Virus/Acquired Immunodeiciency Syndrome
(UNAIDS) that the gonorrhea prevalence in the
general populaion in Indonesia was 20 to 31%
in 2004.2 Meanwhile, data from 2007 Integrated
Biological and Behavioral Surveillance (IBBS) on
the prevalence of STIs in female sexual workers
(FSWs) in Indonesia show that the prevalence of
gonorrhea ranged between 16% and 44%, with
the highest incidence found in West Java.3
Correspondence:
Diah Puspitosari, Faculty of Medicine, Universitas
Padjadjaran-Dr. Hasan Sadikin General Hospital
Jl. Pasteur No. 38, Bandung, Indonesia
e-mail: diahpoppy@gmail.com
Established diagnosis of gonorrhea infecion
is made through Neisseria gonorrhoeae (N.
gonorrhoeae) ideniicaion in the genital tract,
rectal, pharyngeal, and ocular secreion, which
can be done using several methods, such as
microscopic examinaion, culture, and molecular
techniques.1,4–6 Polymerase chain reacion (PCR)
examinaion is one of the molecular techniques
with a higher sensiivity, from 90–100%, than
culture technique which has 68% sensiivity.4–7
This technique has been stated to replace the
culture technique, including for asymptomaic
paients.7
Human immunodeiciency virus (or referred
to as HIV) infecion causes an immunosuppressed
condiion that could increase the number of STIs
and lead to greater co-diagnosis condiion.8,9
People with acive STIs are more prone to HIV
infecion, and vice versa. HIV posiive paients
who are exposed to STIs also have a greater risk
to transmit HIV.9 Some epidemiological data
have suggested that gonorrhea contributes to
Internaional Journal of Integrated Health Sciences. 2014;2(1):1–8
1
Gonorrhoea Infecion Prevalence in Human Immunodeiciency Virus Posiive Paients Based on Polymerase
Chain Reacion Examinaion
increased HIV transmission.10 The frequency of
mucosal HIV increases by 32–41% in gonorrhea
paients and its transmission risk increases to
approximately 2–5 imes higher.11–14
Several factors that contribute to the increase
of HIV infecion are HIV-infected cell withdrawal
in the genital tract as a part of the immune
response and cluster of difereniaion, in this
case the CD4, lymphocyte simulaion that will
eventually lead to increased replicaion of HIV.12
From the immunology perspecive, the
presence of gonorrhea increases HIV shedding
on the genital tract which atracts CD4 T
lymphocytes as a part of the inlammatory
response against patogen.10,11,15 In addiion to
the viral sheddings, the fact that some people
with HIV and AIDS are sill engaged in some high
risk sexual behaviors becomes the key factor in
STI co-infecions, including gonorrhea, with HIV
and AIDS.16–20
Sexually transmited infecions in people with
HIV suggest the possibility that these people
may sill be engaged in risky sexual behaviors.
These infecions could be a risk factor for HIV
transmission to uninfected populaion.16 Other
studies also support this.9,17 Manning et al.18
revealed that high-risk sexual pracices sill
occur among some segments of HIV posiive
populaion. To decrease associated morbidity
and prevent the secondary spread of HIV and
STIs, prevenion eforts should focus on HIV
posiive paients who are sill engaged in highrisk sexual pracices.
Thus, data regarding gonorrhea infecion in
people with HIV are criical for the prevenion,
screening, and treatment of HIV to reduce HIV
transmission.16,19 However, unil recently, data on
STI prevalence, including data on asymptomaic
gonorrhea in individuals with HIV posiive, are
sill limited.3,10,21
Unil now, there are sill limited numbers
of publicaion available on the prevalence of
gonorrhea infecion among HIV posiive paients
in Indonesia; therefore this study aimed to
determine the prevalence of gonorrhea infecion
in male urethra and female cervix of HIV posiive
paients based on PCR examinaion results in
Teratai Clinic, Dr. Hasan Sadikin General Hospital,
Bandung.
Methods
This study is a cross-secional observaional study
performed to 81 HIV posiive paients who visited
Teratai Clinic, Dr. Hasan Sadikin General Hospital
Bandung, Indonesia. The subjects were taken
in consecuive admission in July 2012. The HIV
2
serostatus of the study populaion had already
been determined and conirmed based on the
procedures stated in the Naional Guideline for
HIV before the study. Sexually acive HIV posiive
paients atending Teratai Clinic were ofered to
paricipate in this study. Fourty eight males and
33 females were enrolled ater signing writen
informed consent. Women having her menstrual
period were excluded from the study.
The subjects underwent history taking and
physical examinaion. Sample was collected from
urethral swab in male and cervical swab in female
for PCR examinaion. Comprehensive data on
paient’s characterisics and sexual history were
obtained through history taking and medical
records. The history taking, clinical examinaion,
and specimens collecions were performed in
Teratai Clinic while the specimen processing was
conducted at the Biology Molecular Laboratory,
Microbiology Department, Faculty of Medicine,
Universitas Padjadjaran, Bandung.
The protocol of this study was reviewed
and approved by the Ethical Commitee of the
Faculty of Medicine of Universitas PadjadjaranDr. Hasan Sadikin General Hospital, Bandung.
Specimen collecion kits (Roche) was used for
urethral swab for male paients and endocervical
swab for female paients. Transport medium
tubes (Roche) were used for transporing the
specimens to the laboratory on the day of the
collecion. Immediately ater arrival at the
laboratory, the urethral and endocervical swab
specimens were prepared for the PCR assay as
instructed by the manufacturer, kept frozen at
-20 °C, and analyzed within 14 days of sampling.
Transport medium tubes were thoroughly mixed
and 100 mL was withdrawn and diluted to 1 mL
with sucrose-phosphate medium. Ater that, 1
mL of swab specimen diluent (F. Hofmann-La
Roche Ltd., Basel, Switzerland), was added and
the prepared specimens were frozen at -20 °C
for PCR.
The PCR assay was accomplished using Roche
CT/NG Amplicor PCR kit and the ampliicaion
process was conducted by using a thermocycler
machine. Roche CT/NG Amplicor PCR kit for N.
gonorrhoeae (Roche Moecular System, Inc.,
Brancburb, USA) is a qualitaive in vitro test for the
detecion of N. gonorrhoeae DNA in urine from
symptomaic and asymptomaic males and in
endocervical swab specimen from symptomaic
and asymptomaic females as evidence of N.
gonorrhoeae infecion. N. gonorrhoeae DNA
is detected by PCR ampliicaion of target DNA
and by hybridizaion capture of ampliied
target. Ater the ampliicaion, the ampliied
nucleoide sequences were detected using an
enzyme immunoassay and the A450s were then
Internaional Journal of Integrated Health Sciences. 2014;2(1):1–8
Diah Puspitosari, Asmaja Soedarwoto, et al.
measured with a spectrophotometer (Muliskan;
Labsystems Ltd., Findland).
As stated in the Operator’s Manual for the
Amplicor Analyzer, the results were seen in the
print out for the lags. Interpretaion of the results
is as follow: posiive result for N. gonorrhoeae
is conirmed if the value of the examinaion
materials >3.5 and a negaive result is conirmed
if the value of the examinaion materials