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Background The duration of rectal gonococcal and chlamydial infection remains unknown. This basic epidemiologic parameter is needed to understand transmission dynamics. Methods We conducted a prospective, longitudinal, observational cohort study of 140 men who have sex with men (MSM) at risk of gonorrhea and chlamydia acquisition. For 48 weeks, enrolled men collected rectal swabs (Aptima multi-test kit) at home and responded to an electronic survey about sexual behavior and health conditions weekly. Swabs remained untested until participants completed the study. We used Kaplan-Meier estimates to determine the median duration of infection, censoring infections for treatment, loss to follow-up, and end-of-study. We used log-rank test to compare duration of infection by human immunodeficiency virus (HIV) status, history of infection with gonorrhea or chlamydia, and coinfection with the other pathogen. Results 140 enrolled MSM contributed 70.5 person-years of follow-up. Eighteen men had 20 incident rectal gonococcal infections, which persisted for 2–23 weeks; 30% were censored for treatment. The estimated median duration of rectal gonorrhea was 9 weeks (95% confidence interval [CI]: 3–12 weeks). Twenty-four men experienced 32 rectal chlamydial infections, persisting between 2 and 42 weeks; 60% were censored. The estimated duration of rectal chlamydia was 13 weeks (95% CI: 6 weeks–undefined). There were no differences in the duration of rectal gonorrhea or chlamydia by HIV status, history of chlamydia/gonorrhea, or coinfection. Conclusions On average, rectal gonorrhea and chlamydial infections last 2–3 months, although some infections persisted for 6–11 months. Further understanding into predictors of persistence is needed.

Background Pharyngeal gonorrhea is relatively common. However, the duration of untreated pharyngeal gonorrhea is unknown. Methods From March 2016 to December 2018, we enrolled 140 men who have sex with men in a 48-week cohort study. Participants self-collected pharyngeal specimens and completed a survey weekly. Specimens were tested using a nucleic acid amplification test at the conclusion of the study. We estimated the incidence and duration of infection. We defined incident infections as 2 consecutive positive tests, and clearance as 2 consecutive negative tests; and, after visual inspection of the data, we reclassified up to 2 weeks of missing or negative tests as positive if they occurred between 2 episodes of infections. We used Kaplan-Meier estimates to define duration of infection. Finally, we report on the frequency of single-positive tests and the time between the last negative test and the positive test. Results Nineteen (13.6%) of 140 participants experienced 21 pharyngeal infections (incidence, 31.7/100 person-years; 95% confidence interval, 20.7–48.6/100 person-years). The estimated median duration of pharyngeal gonorrhea was 16.3 weeks (95% confidence interval, 5.1–19.7 weeks). Twenty-two men had 25 single-positive specimens, a median of 7 days (interquartile range, 7–10 days) after their last negative test. Conclusions The median duration of untreated pharyngeal gonorrhea is 16 weeks, more than double previous estimates. This long duration of infection likely contributes to high levels of gonorrhea transmission.

BACKGROUNDCoronavirus disease 2019 (COVID-19) is associated with endothelial activation and coagulopathy, which may be related to pre-existing or infection-induced pro-thrombotic autoantibodies such as those targeting angiotensin II type I receptor (AT1R-Ab).METHODSWe compared prevalence and levels of AT1R-Ab in COVID-19 cases with mild or severe disease to age and sex matched negative controls.RESULTSThere were no significant differences between cases and controls. However, there were trends toward a higher proportion with AT1R-Ab positivity among severe cases versus controls (32% vs. 11%, p=0.1) and higher levels in those with mild COVID-19 compared to controls (median 9.5U/mL vs. 5.9U/mL, p=0.06).CONCLUSIONSThese findings suggest that AT1R-Ab are not consistently associated with COVID-19 but do not exclude a contribution to endothelial pathology in a subset of people.

The fate of protective immunity following mild SARS-CoV-2 infection remains ill defined. Here we characterize antibody responses in a cohort of participants recovered from mild SARS-CoV-2 infection with follow up to 6 months. We measure IgA, IgM, and IgG binding and avidity to viral antigens and assess neutralizing antibody responses over time. Further, we correlate the effect of fever, gender, age, and time since symptom onset with antibody responses. We observe that total anti-S trimer, anti-RBD, and anti-NP IgG are relatively stable over 6 months of follow-up and anti-S and anti-RBD avidity increases over time, and that fever is associated with higher levels of antibodies. However, neutralizing antibody responses rapidly decay and are strongly associated with declines in IgM levels. Thus, while total antibody against SARS-CoV-2 may persist, functional antibody, particularly IgM, is rapidly lost. These observations have implications for the duration of protective immunity following mild SARS-CoV-2 infection., Graphical Abstract, Harrington et al., report that in adults with mild COVID-19, IgG responses are maintained for over six months and are correlated with fever. Neutralization activity rapidly decays, correlating with the loss of anti-S-trimer IgM titers. Thus, neutralizing antibodies fade quickly after mild COVID-19 infection, despite the long-term maintenance of IgG.

Background The duration of untreated extragenital gonococcal (GC) and chlamydial infection (CT) infection is not well defined. Methods From March 2016 to December 2018, we enrolled 140 MSM in a 12-month cohort study. Men ≥18 years were eligible if they reported receptive anal intercourse and had ≥1 following risks in ≤12 months: 1) diagnosis of GC, CT or syphilis; 2) methamphetamine or poppers use; or 3) >2 sex partners in ≤2 months or >5 in ≤12 months. Enrolled men either tested negative for GC/CT at enrollment, or, tested positive, were treated and waited 2–3 weeks prior to data collection. Each week, men self-collected pharyngeal and rectal specimens and completed an electronic diary. Specimens were tested after study completion (Aptima, Hologic Inc). We defined incident infections as two consecutively positive tests and clearance as >2 consecutively negative tests. We used Kaplan Meier curves to estimate duration of infection censoring subjects for receipt of pathogen-specific antibiotic, positive swab in final week of study, or loss-to-follow-up. Results Forty-eight men were observed for 1,687 weeks and contributed 3,579 tested specimens. Twenty-four (50%) MSM had ≥1 incident GC/CT infection; 13 (27%) had >1 infection. Overall extragenital GC/CT incidence was 129 (95%CI: 94–172) infections per 100 person-years. Pharyngeal GC, and rectal GC and CT incidence were 35 (95%CI: 20–61), 37 (95%CI: 22–64) and 59 (95%CI: 38–91) per 100 person-years, respectively. 46% (6/13) pharyngeal GC, 43% (6/14) rectal GC, 81% (17/21) rectal CT were censored. The estimated median duration of pharyngeal GC, rectal GC and rectal CT were 15 (95%CI 3 – undefined), 12 (95%CI 2 – undefined) and >20 (95% CI 12 – undefined) weeks. Conclusion Among high-risk MSM, incident extragenital GC/CT occur frequently: >1 infection per person per year. Untreated, these infections persist for a median of 3 to 5 months. Disclosure No significant relationships.

Background Little is known about the natural history of rectal and pharyngeal Mycoplasma genitalium (MG). Methods From March 2016 to December 2018, we enrolled 140 high-risk MSM in a 12-month cohort study. Eligibility criteria included: age ≥18 years, report of receptive anal intercourse, and ≥1 of the following in ≤12 months: (1) gonorrhea, chlamydia or syphilis; (2) methamphetamine or popper use, or (3) ≥2 sex partners in ≤2 months or ≥5 in ≤12 months. Each week, men collected pharyngeal and rectal swabs and completed an electronic sex diary. We tested swabs for MG (Aptima, Hologic, Inc.) at study completion. Infection was defined as ≥2 consecutive positive tests; clearance was ≥2 consecutively negative tests. We calculated person-weeks-at-risk to estimate incidence and used Kaplan Meier curves to estimate duration of infection. We censored subjects who had a positive swab in the final study week, received doxycycline or azithromycin and obtained clearance in the following 3 weeks, or were lost-to-follow-up. None received moxifloxacin. Results At week 1, the prevalence of rectal and pharyngeal MG was 8% (4/48) and 2% (1/48), respectively. Among 48 men with results from 3,579 specimens, 12 (25%) had ≥1 rectal, and 5 (10%) had ≥1 pharyngeal MG infection. In 1,504 person-weeks-at-risk, rectal MG incidence was 38 (95%CI: 19–68) infections per 100 person-years. In 1,715 person-weeks-at-risk, pharyngeal MG incidence was 15 (95%CI: 5–35) per 100 person-years. Forty percent (6/15) of rectal and 50% (3/6) of pharyngeal infections were censored. Rectal and pharyngeal infections had estimated median durations of 30 (95%CI: 6 – undefined) and 16 (95%CI: 3 – undefined) weeks, respectively. Blips, single positive tests that did not meet criteria for infection, occurred in 8 (17%) men with 17 rectal and 4 (8%) men with 10 pharyngeal MG-positive tests. Conclusion xtragenital, MG, including pharyngeal infection, is common and persistent among high-risk MSM. Disclosure No significant relationships.

Homelessness has not previously been identified as a risk factor for respiratory syncytial virus (RSV) infection. We conducted an observational study at an urban safety-net hospital in Washington, USA, during 2012–2017. Hospitalized adults with RSV were more likely to be homeless, and several clinical outcome measures were worse with RSV than with influenza.