Introducción La incidencia de infección por Chlamydia trachomatis (CT) ha aumentado en los últimos años, especialmente en mujeres jóvenes y puede tener importantes consecuencias en su salud sexual/reproductiva. Métodos Se ofreció un cribado de infección por CT a mujeres que acudieron a la consulta de Matrona/Ginecología del Hospital de Mendaro (Gipuzkoa) entre febrero y junio de 2017 a mujeres de 18-35 años, y se amplió entre septiembre de 2017 y febrero de 2021 a mujeres de 18-25. Tras su consentimiento, se rellenó una encuesta clínico-epidemiológica y obtuvo muestra genital. Se detectó CT con una técnica comercial de PCR. Resultados Se estudiaron a 558 mujeres, 412 de 18-25 años y 146 de 26-35. La prevalencia de infección fue 7,3% (IC95% 5,4-9,9%), 9,0% en≤25 años y 2,7% en mayores de 25 (p=0,013). La prevalencia fue mayor en mujeres sintomáticas, con más parejas sexuales y empleo irregular de preservativo. Conclusión La alta prevalencia de infección por CT en mujeres≤25 años indica la conveniencia de implementar estrategias de cribado para prevenir las consecuencias de la infección y su transmisión.

INTRODUCTION:The incidence of Chlamydia trachomatis (CT) infection has increased in recent years, especially in young women, and can have significant consequences for their sexual and reproductive health. METHODS:Between February/2017-June/2017, screening for CT infection was offered to women aged 18-35 years who attended the Midwife/Gynecology clinic at Mendaro Hospital (Gipuzkoa), and it was extended between September/2017-February/2021 in those aged 18-25. After providing consent, a clinical-epidemiological survey was completed and a genital sample was obtained. CT was detected using a commercial PCR technique. RESULTS:A total of 558 women were studied: 412 aged 18-25 years and 146 aged 26-35 years. The prevalence of infection was 7.3% (95%CI 5.4-9.9%), 9.0% in those aged ≤25 years and 2.7% in those older than 25 (p = 0.013). The prevalence was higher in symptomatic women, with more sexual partners, and inconsistent condom use. CONCLUSION:The high prevalence of CT infection in women aged ≤25 years indicates the need to implement screening strategies to prevent the consequences of infection and its transmission.

While macrolide resistance in Mycoplasma genitalium is consistently associated with mutations in the 23S rRNA gene, enabling macrolide resistance-guided therapies, the correlation between genotype and fluoroquinolone resistance is less definitive. We aim to estimate the contribution of ParC -and GyrA- mutations in M. genitalium to fluoroquinolone resistance through a systematized review of the scientific literature. On May 2025, a Boolean search was performed in PubMed for manuscripts reporting fourth-generation fluoroquinolone-based treatment outcomes in M. genitalium infections harboring ParC mutations at S83 and/or D87. Concurrent GyrA mutations were also recorded. Sixteen studies were included in the review, accounting for 376 M. genitalium infections. Most treatment failures were associated with the S83I variant in ParC, where 43% of cases receiving fluoroquinolones failed. While the rate of treatment failure estimated among S83R variants was slightly higher (50%), this mutation was much less frequently identified. On the other hand, no treatment failures were identified associated with mutations S83N, D87G and D87H. Concomitant GyrA mutation M95I or variations affecting D99 significantly increased the rate of treatment failure up to three-fold. Sitafloxacin was significantly more effective than moxifloxacin in the presence of resistance mutations. This descriptive review provides compilated and preliminary data regarding the contribution of parC and gyrA mutations to fluoroquinolone resistance, to be considered in diagnostic assay designs. This may ultimately lead therapeutic decision-making guidance.

IntroductionA microbiological diagnosis is not reached in many urethritis cases, the proportion varying with the diagnostic methods and targets available. Mycoplasma penetrans is an emerging pathogen, recently described as a possible aetiological agent in urethritis, especially in men who have sex with men (MSM) and persons living with HIV.MethodsBetween June 2021 and June 2024, urethral samples from men were analysed for the presence of M. penetrans using an in-house real-time PCR, and for other sexually transmitted infections with standard techniques (gram stain, culture, PCR, and serology). Three groups were studied, one comprising 55 consecutive cases of urethritis in which the infectious aetiology had not previously been identified, and two randomly obtained control groups: 102 patients with microbiologically-identified urethritis, and 91 patients with no manifestations of urethritis and no pathogen detected.Results and discussionM. penetrans DNA was detected in 7/55 (12.7%) of the idiopathic urethritis cases, but not in any of the controls (p < 0.001). None of the M. penetrans-positive patients had HIV infection and six were MSM. The results from this study indicate an association between infection by M. penetrans and urethritis in men. Therefore, the use of techniques for detecting M. penetrans could help bridge the diagnostic gap in idiopathic urethritis.

Enterovirus D68 (EV-D68) infections are associated with severe respiratory disease and acute flaccid myelitis (AFM). The European Non-Polio Enterovirus Network (ENPEN) aimed to investigate the epidemiological and genetic characteristics of EV-D68 infections and its clinical impact during the fall-winter season of 2021-2022. From 19 European countries, 58 institutes reported 10 481 (6.8%) EV-positive samples of which 1004 (9.6%) were identified as EV-D68 (including 852 respiratory samples). Clinical data were reported for 969 cases; 78.9% of infections were reported in children (0-5 years); and 37.9% of cases were hospitalized. Acute respiratory distress was commonly noted (93.1%) followed by fever (49.4%). Neurological problems were observed in 6.4% of cases including 6 diagnosed with AFM. Phylodynamic/Nextstrain and phylogenetic analyses based on 694 sequences showed the emergence of 2 novel B3-derived lineages, with no regional clustering. In conclusion, we describe a large-scale European EV-D68 upsurge with severe clinical impact and the emergence of B3-derived lineages.

Introduction Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by Chlamydia trachomatis genotypes L1-L3. A combination of techniques with high discriminatory capacity such as multilocus sequence typing (MLST) and the analysis of the ompA gene may be useful to determine the greater penetration of certain strains in transmission networks and their relationship with certain tropisms.Aim The aim of this study was to investigate the molecular epidemiology of LGV isolates from different regions of Spain.Methods Genetic characterisation of LGV isolates detected in six hospitals from Spain between 2018 and 2019 was performed. MLST (five variable regions: hctB, CT058, CT144, CT172 and pbpB) and ompA sequence determination were used to study the LGV strains.Results Most of the 161 LGV isolates (93.8%) were detected in men who have sex with men (MSM). At least 43.5% of the patients presented with HIV coinfection and 53.4% were symptomatic, with proctitis being the most prevalent symptom (73.3%). Most isolates were detected in Barcelona (n=129). The distribution of ompA genovariants was as follows: 56.1% belonged to L2, 24.3% to L2b, 5.4% to L2bV1, 4.7% to L2bV4, 4.1% to L1, 2.7% to L2b/D-Da, 2.0% to L2bV2 and 0.7% to L2bV7. MLST was successfully performed in 81 samples and 9 different sequence types (STs) were detected. The ompA and MLST combination obtained 17 different genetic profiles, with L2-ST53 and L2-ST58 being the most prevalent (29.5% and 14.1%, respectively). L1 genotype strains belonged to ST23 (n=3) and ST2 (n=3).Results Most of the 161 LGV isolates (93.8%) were detected in men who have sex with men (MSM). At least 43.5% of the patients presented with HIV coinfection and 53.4% were symptomatic, with proctitis being the most prevalent symptom (73.3%). Most isolates were detected in Barcelona (n=129). The distribution of ompA genovariants was as follows: 56.1% belonged to L2, 24.3% to L2b, 5.4% to L2bV1, 4.7% to L2bV4, 4.1% to L1, 2.7% to L2b/D-Da, 2.0% to L2bV2 and 0.7% to L2bV7. MLST was successfully performed in 81 samples and 9 different sequence types (STs) were detected. The ompA and MLST combination obtained 17 different genetic profiles, with L2-ST53 and L2-ST58 being the most prevalent (29.5% and 14.1%, respectively). L1 genotype strains belonged to ST23 (n=3) and ST2 (n=3).Conclusion LGV infections were mainly found in MSM living with HIV and with proctitis. The joint analysis of ompA and MLST genetic characterisation techniques showed a high discriminatory capacity. Our findings suggest a cocirculation of L2 and L2b ompA genotypes, and with the inclusion of MLST characterisation, the most prevalent profiles were ompA genotype L2-MLST ST53 and L2-MLST ST58.

Chlamydia trachomatis infection is an important public health problem. Our objective was to assess the dynamics of the transmission of this infection, analysing the distribution of circulating ompA genotypes and multilocus sequence types of C. trachomatis in Spain as a function of clinical and epidemiological variables. During 2018 and 2019, we genetically characterized C. trachomatis in tertiary hospitals in six areas in Spain (Asturias, Barcelona, Gipuzkoa, Mallorca, Seville and Zaragoza), with a catchment population of 3.050 million people. Genotypes and sequence types were obtained using polymerase chain reaction techniques that amplify a fragment of the ompA gene, and five highly variable genes (hctB, CT058, CT144, CT172 and pbpB), respectively. Amplicons were sequenced and phylogenetic analysis was conducted. We obtained genotypes in 636/698 cases (91.1%). Overall and by area, genotype E was the most common (35%). Stratifying by sex, genotypes D and G were more common among men, and genotypes F and I among women (p < 0.05). Genotypes D, G and J were more common in men who have sex with men (MSM) than in men who have sex with women (MSW), in whom the most common genotypes were E and F. The diversity index was higher in sequence typing (0.981) than in genotyping (0.791), and the most common sequence types were ST52 and ST108 in MSM, and ST30, ST148, ST276 and ST327 in MSW. Differences in genotype distribution between geographical areas were attributable to differences in population characteristics. The transmission dynamics varied with sexual behaviour: the predominant genotypes and most frequent sequence types found in MSM were different to those detected in MSW and women.

The aim of this multicentre project (seven hospitals across the Spanish National Health Service) was to study the phenotypic and genotypic susceptibility of C. trachomatis to the main antimicrobials used (macrolides, doxycycline, and quinolones) in isolates from patients with clinical treatment failure in whom reinfection had been ruled out. During 2018–2019, 73 clinical isolates were selected. Sixty-nine clinical specimens were inoculated onto confluent McCoy cell monolayers for phenotypic susceptibility testing. The minimum inhibitory concentration for azithromycin and doxycycline was defined as the lowest concentration associated with an at least 95% reduction in inclusion-forming units after one passage in the presence of the antibiotic compared to the initial inoculum for each strain (control). Sequencing analysis was performed for the genotypic detection of resistance to macrolides, analysing mutations in the 23S rRNA gene (at positions 2057, 2058, 2059, and 2611), and quinolones, analysing a fragment of the gyrA gene, and searching for the G248T mutation (Ser83->Ile). For tetracyclines, in-house RT-PCR was used to test for the tet(C) gene. The phenotypic susceptibility testing was successful for 10 isolates. All the isolates had minimum inhibitory concentrations for azithromycin ≤ 0.125 mg/L and for doxycycline ≤ 0.064 mg/L and were considered sensitive. Of the 73 strains studied, no mutations were found at positions T2611C or G248T of the gyrA gene. We successfully sequenced 66 isolates. No macrolide resistance-associated mutations were found at positions 2057, 2058, 2059, or T2611C. None of the isolates carried the tet(C) gene. We found no evidence for genomic resistance in this large, clinically relevant dataset.

AbstractObjectiveTo assess a screening program for sexually transmitted infections (STIs) in under‐30‐year‐old pregnant women, focusing on Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections, which though often asymptomatic, may significantly affect women's health and can be vertically transmitted.DesignProspective, descriptive, observational study.SettingGipuzkoa (Basque Country, Spain).PopulationUnder‐30‐year‐old pregnant women.MethodsBetween 2016 and 2020, cervical samples were taken at first prenatal appointments from 3051 women. STIs were detected by multiplex nucleic acid amplification.Main Outcome MeasuresPrevalence of infections by age and geographical origin groups, and screening coverage.ResultsThe coverage rate was 86% between 2017 and 2020. At least one STI was detected in 5.2% of the under‐30‐year‐olds screened (95% confidence interval [CI]: 4.5%, 6.1%): C. trachomatis in 4%, M. genitalium in 1.3% and N. gonorrhoeae in 0.1%. C. trachomatis and M. genitalium prevalence rates were higher among younger women (7.2% and 2.8%, respectively in under‐25‐year‐olds), while C. trachomatis prevalence in 25‐ to 30‐year‐olds was 2.5%. C. trachomatis was more common among Latin American women (9.7% [95% CI: 7.4%, 12.3%] vs. 2.5% [95% CI: 2.0%, 3.2%] in other women). Additionally, analysing samples from 708 pregnant over‐30‐year‐old women with STI risk factors, 1.6% had at least one of the STIs studied. Notably, 20% of all cases had STI‐related symptoms or complications during pregnancy.ConclusionsThe high coverage achieved, and prevalence, clinical and epidemiological results support the view that the implementation of a screening program across Spain for C. trachomatis in under‐30‐year‐old pregnant women would be both feasible and appropriate.Tweetable abstractHigh Chlamydia trachomatis infection prevalence (4%) and coverage (>80%) in local program support pregnancy screening across Spain.

The management of Mycoplasma genitalium sexually transmitted infection (STI) is hindered by increasing resistance to the recommended antibiotics, macrolides and quinolones, worldwide. In Gipuzkoa (Basque Country, Spain), macrolide and quinolone resistance rates in 2014–2018 were reported as <20% and <10%, respectively. The aims of this study were to compare these rates with those in 2019–2021 and analyse the genetic and epidemiological features of the strains and cases associated with striking changes in the resistance trends. Resistance to macrolides (n = 1019) and quinolones (n = 958) was studied, analysing mutations in 23S rRNA and parC/gyrA genes, respectively. The rate of macrolide resistance increased from 17.3% in 2014–2018 to 32.1% in 2019–2021, as much in the more prevalent A2058/2059G mutations (16.6–27.8%) as in the emergent A2058T mutations (0.5–4.1%) but with differences in the odds ratios and the relative risk increase between A2058T and A2058/2059G mutations. MG191 adhesin and MG309 lipoprotein of the 27 emergent strains detected with A2058T mutations were amplified, sequenced, and typed using phylogenetic and variable number tandem repeat analysis, respectively. Genetic clonal spread was ruled out, but most of the A2058T cases were men who had sex with men (24/27) with a history of STI and antibiotic treatments (19/27). No changes were observed in quinolone resistance trends, but the rate of resistance to both antibiotics rose from 2.9% to 8.3%, especially in cases with A2058T mutations. The genetic characterisation of strains and epidemiological surveillance of cases are needed to detect populations at increased risk of treatment failure in this infection.

Objective Real-time surveillance of SARS-CoV-2 variants of concern (VOC) is of essential public health importance. Rapid Antigen Detection Tests (RAgDT) have become first-line COVID-19 diagnostic methods in many regions, but this strategy can hamper the surveillance of the virus variants due to their decentralized performance. The aim of this study was to assess the usefulness of the remaining sample of a widely used RAgDT (Panbio) for the surveillance of the B.1.1.7 VOC using molecular methods. Methods Symptomatic individuals and asymptomatic close contacts of confirmed cases were routinely screened for SARS-CoV-2 infection using the RAgDT in Primary Health Care Centers. After performing the test, the extraction tubes containing the remaining biological material of RAgDT-positive cases were sent to the clinical microbiology laboratory where RT-PCRs detecting key mutations of the VOC were conducted. Results A valid result was obtained in 1770/1812 (97.7%) RAgDT-positive cases. Variant B.1.1.7 was detected in 34.7% of the patients, increasing from 0% to 87.7% between the weeks beginning January 4 and March 15, 2021. Conclusion The sample remaining after performing the Panbio RAgDT allowed to monitor the emergence and circulation of the B.1.1.7, greatly improving the population screened for the molecular study of SARS-CoV-2 variants.

We report a rapid increase in enterovirus D68 (EV-D68) infections, with 139 cases reported from eight European countries between 31 July and 14 October 2021. This upsurge is in line with the seasonality of EV-D68 and was presumably stimulated by the widespread reopening after COVID-19 lockdown. Most cases were identified in September, but more are to be expected in the coming months. Reinforcement of clinical awareness, diagnostic capacities and surveillance of EV-D68 is urgently needed in Europe.

ABO blood groups have recently been related to COVID19 infection. In the present work, we performed this analysis using data from 412 COVID19 patients and 17796 blood donors, all of them from Gipuzkoa, a region in Northern Spain. The results obtained confirmed this relation, in addition to showing a clear importance of group O as a protective factor in COVID19 disease, with an OR = 0.59 (CI95% 0.481-0.7177, p<0.0001) while A, B and AB are risk factors. ABO blood groups are slightly differently distributed in the populations and therefore these results should be replicated in the specific areas with a proper control population.

Este estudio fue parcialmente financiado con una beca del Fondo de Investigacion Sanitaria (FIS PI10/02191).

Introduction: The objective of this study was to analyse the susceptibility of Mycoplasma genitalium to macrolides and fluoroquinolones using molecular techniques. Methods: Susceptibility to macrolides was tested (Gipuzkoa, 2014-2017) by a rapid probe-based real-time polymerase chain reaction assay (23S rRNA gene) and to fluoroquinolones by sequencing the parC and gyrA genes. Results: Mutations associated with macrolide resistance were detected in 43/263 (16.3%) cases and potential fluoroquinolone resistance in 21/267 (7.9%). Macrolide resistance was more frequent in patients previously treated with azithromycin (76.5% vs 7.4%, P <.001) as well as in those treated with a single 1 g dose (31.3%) vs the extended regimen (7%, P<.001). There were 5/245 (2%) cases with mutations probably associated with resistance to both antibiotics. Conclusions: The technique used for testing Mycoplasma genitalium susceptibility to azithromycin allowed the rapid implementation of resistance-guided antibiotic therapy. Moxifloxacin could be a good option in cases of macrolide resistance. (C) 2018 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.

tive compared to its use against Neisseria gonorrhoeae. In addition, the risk of neonatal ophthalmia due to C. trachomatis is currently greater compared to the risk due to N. gonorrhoeae, as the former is more prevalent in pregnant women.3,5 For all the above reasons, the health authorities in some countries recommend screening pregnant women (which requires definition of the target population based on the prevalence of infection by age groups) and treating those infected, while the usefulness of neonatal prophylaxis remains under debate.1,3,6 Screening during pregnancy would allow the prevention of complications in the mother (pelvic inflammatory disease, sterility, etc.) and reduce the burden of disease in newborns, as maternal infection would be controlled before delivery. In conclusion, based on our findings, we estimate that at least 1 in 1000 newborns in Spain acquires a C. trachomatis infection during birth, despite the routine implementation of ocular prophylaxis in newborns.

Sexually transmitted infections caused by Chlamydia trachomatis, including lymphogranuloma venereum and Mycoplasma genitalium have increased in last decade. This epidemiological scenario presents new challenges in order to improve and strengthen our control and prevention strategies. The routine clinical diagnosis of urethritis and cervicitis must be combined with the active search for the causal agent in men with symptoms of dysuria or proctitis, and in women with pelvic inflammatory disease. We should also include sexually transmitted infections screening in asymptomatic patients with sexual risk behaviours or sexual contact with patients diagnosed with an sexually transmitted infection. The microbiological diagnosis must be based on molecular techniques capable of detecting Chlamydia trachomatis (discriminating between L genotypes associated with lymphogranuloma venereum and other genotypes) and Mycoplasma genitalium (ideally including the identification of macrolide-resistant strains). A faster and specific diagnosis will allow for a targeted treatment with a suitable antibiotic regimen. We also recommend including contact tracing of sexual partners and, occasionally, a cure test. Finally, sexually transmitted infection screening must be widely implemented in those population groups with a high prevalence of sexually transmitted infections. (C) 2019 Elsevier Espana, S.L.U. and Sociedad Espanola de Enfermedades Infecciosas y Microbiologia Clinica. All rights reserved.