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#4-6-1

Unit 6: Specialised Techniques: Anti-Microbial Resistance Monitoring and Assessment of STI Syndrome Aetiologies. #4-6-1. Warm Up Questions: Instructions. Take five minutes now to try the Unit 6 warm up questions in your manual. Please do not compare answers with other participants.

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#4-6-1

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  1. Unit 6: Specialised Techniques: Anti-Microbial Resistance Monitoring and Assessment of STI Syndrome Aetiologies #4-6-1

  2. Warm Up Questions: Instructions • Take five minutes now to try the Unit 6 warm up questions in your manual. • Please do not compare answers with other participants. • Your answers will not be collected or graded. • We will review your answers at the end of the unit. #4-6-2

  3. What You Will Learn • By the end of this unit you should be able to: • discuss the objectives of anti-microbial resistance monitoring in N. gonorrhoeae and H. ducreyi • discuss why assessment of syndrome aetiologies is a core component of a comprehensive STI surveillance system • describe the two main STI syndromes and their microbiological causes • discuss how data from assessments of syndrome aetiologies are used to revise syndromic treatment guidelines #4-6-3

  4. Monitoring of Anti-Microbial Resistance of STI Pathogens • Resistance is the alteration of a pathogen, making it non-responsive to a particular drug. • Monitoring helps identify which groups are at higher risk of infection with resistant strains and helps to detect newly emerging resistance. • Appropriate treatment can then be planned. #4-6-4

  5. Laboratory Requirements • Surveys are usually organised by the national AIDS/STI control programme. • Choose sites with well-trained staff and laboratory expertise. • Lab should be able to: • culture organism • perform serologic confirmatory tests • perform MIC agar dilution testing • If no national lab support is available, isolates can be sent to another country for testing. #4-6-5

  6. Planning the Testing • Sample size depends on: • expected prevalence of disease in population • whether sample will be used to monitor trends over time • Possible types of sampling are: • random • systematic • consecutive #4-6-6

  7. Frequency of Assessment • At least once a year • Best to sample on an ongoing basis • Resistance can thus be detected early on • For example, test 20 isolates per month at each sentinel site #4-6-7

  8. Data Analysis and Interpretation • Microbiologists familiar with test sensitivity and specificity should interpret results. • If a change is noted, determine if it is due to: • real shifts in resistance patterns • problems in the laboratory • If shifts are noted, do the following to explore the problem or resistance pattern: • expand sample • increase number of sites #4-6-8

  9. What Should be Done with Resistance Data • Resistance should be reported immediately to a WHO Collaborating Centre. • Resistance data should be used to update treatment guidelines and revise the country list of essential drugs. #4-6-9

  10. Figure 6.1. Frequency of Tetracycline-Resistant N. Gonorrhoeae, 1988-1993 Source: Van Dyck et al., Sex Transm Dis 1997 #4-6-10

  11. Figure 6.2. Frequency of Penicillinase-Producing N. Gonorrhoeae, 1988-1993 Source: Van Dyck et al., Sex Transm Dis 1997 #4-6-11

  12. Disseminating Results • Distribute results on resistance (similar to Figures 6.1 and 6.2) at least annually. • This assists interpretation of test results for patients whose previous therapies failed. • Information in report should include: • gender of patients • clinic setting where patients were tested • changes in sentinel sites over time #4-6-12

  13. Assessing STI Syndrome Aetiologies • Involves determining which micro-organisms cause urethral discharge and genital ulcer disease • Especially important where syndromic case reporting takes place • Should be conducted by the national AIDS/STI control programme every 2-3 years #4-6-13

  14. Objectives of Assessing STI Syndrome Aetiologies • Provide data for guiding STI syndromic management • Assist in interpretation of syndromic case reports and assessment of disease burden due to specific pathogens • Design or modify guidelines for treating urethral discharge and genital ulcers #4-6-14

  15. Laboratory Requirements • Microbiologist experienced in STI diagnostic tests should develop national laboratory protocols. • Range of diagnostic tests is broad. • Choice depends on local availability of laboratory resources. • See Table 6.1 in your manual for laboratory tests for specific STI syndromes. #4-6-15

  16. Where to Conduct the Assessments • Ideally, aetiology assessment should be conducted in: • Different types of populations • Populations with high and low disease rates • Different locations • If your country has limited resources, conduct the assessment in a single specialised STI clinic: • With well-trained staff that can perform Gram stains and microscopy • With the ability to perform syphilis serologic testing #4-6-16

  17. Sample Size • Depends on: • Specific aetiology • Expected prevalence of pathogens • Minimum sample size of 50 or 100 specimens from consecutive patients will provide adequate information for useful analysis. #4-6-17

  18. Data Analysis • Analyse results for each disease separately. • Frequency of various STIs and risk behaviours can then be analysed by: • Gender • Age group • Geographic area • Marital status • Other relevant characteristics #4-6-18

  19. In Summary • Anti-microbial resistance monitoring helps detect emerging resistance and develop treatment guidelines. • Assessing syndrome aetiologies provides information on the relative contributions of different pathogens to the main STI syndromes. • This guides STI syndromic treatment and assists in the interpretation of syndromic case reports. #4-6-19

  20. Warm Up Review • Take a few minutes now to look back at your answers to the warm up questions at the beginning of the unit. • Make any changes you want to. • We will discuss the questions and answers in a few minutes. #4-6-20

  21. Answers to Warm Up Questions, Cont. 1. For countries where syndromic STI case reporting is used, syndrome aetiologies should be reassessed every ________ years. a. one to two b. two to three c. three to four #4-6-21

  22. Answers to Warm Up Questions, Cont. 1. For countries where syndromic STI case reporting is used, syndrome aetiologies should be reassessed every ________ years. a. one to two b. two to three c. three to four #4-6-22

  23. Answers to Warm Up Questions, Cont. 2. True or false? Monitoring anti-microbial resistance of N. gonorrhoeae may help to detect newly emerging resistance. #4-6-23

  24. Answers to Warm Up Questions, Cont. 2. True or false? Monitoring anti-microbial resistance of N. gonorrhoeae may help to detect newly emerging resistance. True #4-6-24

  25. Answers to Warm Up Questions, Cont. • Choose an item below that is not one of the main purposes of assessing syndrome aetiologies. • provide data for guiding STI syndromic management • assess effectiveness of HIV prevention programmes • assist in the interpretation of syndromic case reports and the assessment of disease burden caused by specific pathogens • evaluate syndromic management algorithms for urethral discharge and genital ulcers #4-6-25

  26. Answers to Warm Up Questions, Cont. • Choose an item below that is not one of the main purposes of assessing syndrome aetiologies. • provide data for guiding STI syndromic management • assess effectiveness of HIV prevention programmes • assist in the interpretation of syndromic case reports and the assessment of disease burden caused by specific pathogens • evaluate syndromic management algorithms for urethral discharge and genital ulcers #4-6-26

  27. Answers to Warm Up Questions, Cont. 4. List two possible uses of data obtained from monitoring anti-microbial resistance of STI pathogens. #4-6-27

  28. Answers to Warm Up Questions, Cont. 4. List two possible uses ofdata obtained from monitoring anti-microbial resistance of STI pathogens. Obtain the data necessary for developing and revising treatment guidelines; detect newly emerging resistance #4-6-28

  29. Answers to Warm Up Questions, Cont. 5. Which of the following sampling strategies is the most difficult to use when conducting anti-microbial resistance monitoring? a. random b. systematic c. consecutive #4-6-29

  30. Answers to Warm Up Questions, Cont. 5. Which of the following sampling strategies is the most difficult to use when conducting anti-microbial resistance monitoring? a. random b. systematic c. consecutive #4-6-30

  31. Small Group Discussion: Instructions • Get into small groups to discuss these questions. • Choose a speaker for your group who will report back to the class. #4-6-31

  32. Small Group Reports • Select one member from your group to present your answers. • Discuss with the rest of the class. #4-6-32

  33. Case Study: Instructions • Try this case study individually. • We’ll discuss the answers in class. #4-6-33

  34. Case Study Review • Follow along as we go over the case study in class. • Discuss your answers with the rest of the class. #4-6-34

  35. Questions, Process Check • Do you have any questions on the information we just covered? • Are you happy with how we worked on Unit 6? • Do you want to try something different that will help the group? #4-6-35

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