Sexually transmitted infections case notification rates in the Kingdom of Saudi Arabia, 2005–2012

Introduction: Sexually transmitted infections (STIs) are major public health concerns around the world. This study describes the epidemiology of reported STI cases from 2005 to 2012 in the Kingdom of Saudi Arabia. Methodology: The annual registry was the main source of data as reported by healthcare providers. Case definitions were based on positive human immunodeficiency virus (HIV) antibodies detectable by enzyme-linked immunosorbent assay (ELISA) and confirmed by western blot test for HIV cases. The definitions of other STIs were based on published Centers for Disease Control and Prevention (CDC) definitions. Results: During the study period, 68,886 new cases were reported, with nongonococcal urethritis being the highest STI (25.4) per 100,000 population (25.4), followed by trichomoniasis (9.1), HIV (7), human papillomavirus (HPV) infection (2.9), and syphilis (1.3). The cases included nongonococcal urethritis (n = 35,613; 51.7%), trichomoniasis (n = 12,679; 18.4%), gonococcal urethritis (n = 3,006; 4.4%), syphilis (n = 1,769; 2.6%), HIV (n = 9,843; 14.3%), genital warts (n = 4,018; 5.8%), genital herpes (n = 1,508; 2.2%), and chancroid (n = 450; 0.7%). Saudi contribution to HIV cases increased from 28.9% in the preceding decade to 43.5% in the current study. Conclusions: Nongonococcal urethritis, trichomoniasis, and HIV were the most commonly reported STIs in the Kingdom of Saudi Arabia

Prevalence and behavioral risk factors for STIs/HIV among attendees of the Ministry of Health hospitals in Saudi Arabia

Introduction: Sexually transmitted infections (STI) are a major public health, social, and economic problem leading to morbidity, mortality, and stigma. This study was conducted to determine the prevalence of STIs, investigate behavioral risk factors and the relationship between the STIs/HIV and demographic factors. Methodology: A cross-sectional survey was conducted between 2013 and 2014 among attendees of the Ministry of Health hospitals. Results: The total number of participants was 3,994 (2,441 males and 1,553 females), with a mean age of 31.95 ± 9.45 years (range 12 to 77 years). The prevalence of STIs and HIV was 6.2% and 0.05% respectively. The mean age for infected people with STIs was 29.42 ± 7.51, vs. 32.12 ± 9.55 for non infected (p < 0.05). There was no diffference between infected and non infected people regarding gender, occupation and marital status. The prevalence of STIs was more commonly reported among non-Saudi (10.9%). Drug use (OR = 4.74; 95%; CI: 3.47–6.48), intravenous drug use (OR = 4.51; 95% CI: 1.45–13.12), illegal sex (OR = 10.7; 95% CI: 7.62–13.32), sex for money (OR = 6.36; 95% CI: 4.52–8.93), sex for pleasure (OR=9.76; 95% CI: 7.29–13.07) were significantly associated with STIs. Conclusion: The prevalence of STIs including HIV in Saudi Arabia is low compared to other countries in the region and globally

Al-Hajoj, “Emergence of clinically relevant non-tuberculous mycobacterial infections

Background: Non-Tuberculous Mycobacteria (NTM) are emerging around the world due to a higher prevalence of immunosuppressive illness and therapy. Saudi Arabia is not an exception as there have been novel mycobacterial species also identified. In addition, several published case reports from different parts of the country suggest a growing pathogenic potential of NTM. As the first nationwide study, we sought to gain an insight into the species diversity of NTM clinical isolates. Methodology/Principal findings: During June 2009–July 2010, 95 clinical isolates were collected from tuberculosis reference laboratories in major provinces within Saudi Arabia and subjected to standard line probe assay techniques to identify their species. Diagnostic guidelines of the American Thoracic Society were applied to determine the clinical relevance of respiratory isolates. Species diversity (13 species) was very high and dominated (61.0%) by rapid growing NTM. The major species obtained were Mycobacterium abscessus, M. fortuitum, M. intracellulare followed by M. kansassi, M. gordanae and M. avium. Interestingly this study reports for the first time the clinical relevance of M. celatum, M. xenopi, M. scrofulceum, M. lentiflavum, M. asiaticum and M. simiae in Saudi Arabia. Of the total, 67.1 % were clinically relevant respiratory cases, 23.2 % were non-respiratory cases and 9.7 % were respiratory colonizers. Coexisting illness was reported in 53.7 % of the studied cases. The major risk factors observed among the patients were previous history of tuberculosis, chroni

Emergence of clinically relevant Non-Tuberculous Mycobacterial infections in Saudi Arabia.

BACKGROUND: Non-Tuberculous Mycobacteria (NTM) are emerging around the world due to a higher prevalence of immunosuppressive illness and therapy. Saudi Arabia is not an exception as there have been novel mycobacterial species also identified. In addition, several published case reports from different parts of the country suggest a growing pathogenic potential of NTM. As the first nationwide study, we sought to gain an insight into the species diversity of NTM clinical isolates. METHODOLOGY/PRINCIPAL FINDINGS: During June 2009-July 2010, 95 clinical isolates were collected from tuberculosis reference laboratories in major provinces within Saudi Arabia and subjected to standard line probe assay techniques to identify their species. Diagnostic guidelines of the American Thoracic Society were applied to determine the clinical relevance of respiratory isolates. Species diversity (13 species) was very high and dominated (61.0%) by rapid growing NTM. The major species obtained were Mycobacterium abscessus, M. fortuitum, M. intracellulare followed by M. kansassi, M. gordanae and M. avium. Interestingly this study reports for the first time the clinical relevance of M. celatum, M. xenopi, M. scrofulceum, M. lentiflavum, M. asiaticum and M. simiae in Saudi Arabia. Of the total, 67.1% were clinically relevant respiratory cases, 23.2% were non-respiratory cases and 9.7% were respiratory colonizers. Coexisting illness was reported in 53.7% of the studied cases. The major risk factors observed among the patients were previous history of tuberculosis, chronic obstructive pulmonary disorder and human immunodeficiency virus infection. CONCLUSION/SIGNIFICANCE: The high rates of clinically confirmed respiratory cases suggest that NTM infections are indeed a new challenge to health authorities. The current findings show an opposite picture of the Western world where M. avium complex and particularly slow growing NTM are the most predominant respiratory pathogens. The complexity of species demands an immediate strengthening of the current diagnostic facilities

Tuberculosis transmission among immigrants and autochthonous populations of the eastern province of Saudi Arabia.

BACKGROUND:Eastern province of Saudi Arabia is an industrial zone with large immigrant population and high level of tuberculosis case notification among immigrants. The impact of immigration and current trends of tuberculosis transmission among immigrants and autochthonous population in the region had not been investigated so far using molecular tools. METHODOLOGY:During 2009- 2011, a total of 524 Mycobacterium tuberculosis isolates were collected from the central tuberculosis reference laboratory, representing an estimated 79.2% of the culture-positive tuberculosis cases over the study period in the province. These isolates were genotyped by using 24 locus-based MIRU-VNTR typing and spoligotyping followed by first line drug susceptibility testing. The molecular clustering profiles and phylogenetic diversity of isolates were determined and compared to the geographical origins of the patients. PRINCIPLE FINDINGS:Genotyping showed an overall predominance of Delhi/CAS (29.4%), EAI (23.8%) and Ghana (13.3%) lineages, with slightly higher proportions of Delhi/CAS among autochthonous population (33.3 %) and EAI (30.9%) among immigrants. Rate of any drug resistance was 20.2% with 2.5% of multi-drug resistance. Strain cluster analysis indicated 42 clusters comprising 210 isolates, resulting in a calculated recent transmission index of 32.1%. Overall shared cluster ratio was 78.6% while 75.8% were shared between autochthonous population and immigrant population with a predominance of immigrants from South east Asia (40.7%). In contrast, cross national transmission within the immigrant population was limited (24.2%). Younger age (15-30- p value-0.043, 16-45, p value 0.030), Saudi nationality (p value-0.004) and South East Asian origin (p value-0.011) were identified as significant predisposing factors for molecular strain clustering. CONCLUSIONS:The high proportion of molecular clusters shared among the autochthonous and immigrant populations suggests a high permeability of tuberculosis transmission between both populations in the province. These results prompt for the need to strengthen the current tuberculosis control strategies and surveillance programs

Summary of the 22 extra-pulmonary NTM infections observed in the study.

†<p>Lymphnode/Fine Needle Aspiration/Biopsy.</p>¶<p>Previous mycobacterium tuberculosis disease.</p>‡<p>Cystic fibrosis.</p>*<p>Human immunodeficiency virus.</p

Summary of the 73 pulmonary samples with NTM infections during 2009–2010 from Saudi Arabia.

*<p>Based on ATS/IDSA 2007 guidelines.</p>†<p>Previous mycobacterium tuberculosis disease.</p>‡<p>Human immunodeficiency virus.</p>¶<p>Pulmonary fibrosis.</p>#<p>Cystic fibrosis.</p>±<p>Chronic obstructive pulmonary disease.</p>++<p>Continuous ambulatory peritoneal dialysis.</p

Overall species diversity of 95 clinical non-tuberculous mycobacterial isolates from Saudi Arabia.

<p>The diagram shows collective representation of pulmonary and extra-pulmonary isolates. The number of isolates with particular species are showed at the outer end of the bar diagram.</p

Summary of the study subjects.

<p>Summary of the study subjects.</p