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de Jesus Salgado V, de Abreu Oliveira CMP, da Silva ÁMB, de Brito HIL, de Medeiros DS, Soares F, Magno L, Dourado I, Campos GB, Marques LM. Prevalence of Mollicutes among men who have sex with men and transgender women aged 15 to 19 years in Salvador, North-eastern Brazil. BMC Infect Dis 2023; 23:244. [PMID: 37072756 PMCID: PMC10114492 DOI: 10.1186/s12879-023-08213-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 03/31/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Some species of Mollicutes have been associated with different pathologies of the urogenital tract in humans, with a high prevalence among adult men who have sex with men (MSM) and transgender women (TGW). However, few studies have been performed to investigate its prevalence among adolescents. In this study, we estimated the initial prevalence of Mycoplasma genitalium (MG), Mycoplasma hominis (MH), Ureaplasma urealyticum (UU), and Ureaplasma parvum (UP); the rate of misdiagnosis at different anatomical sites; and the associated factors with positive tests for Mollicutes among MSM and TGW aged 15 to 19 years enrolled in the PrEP1519 study. METHODS PrEP-1519 is the first study to investigate the effectiveness of pre-exposure prophylaxis for human immunodeficiency virus among adolescent MSM and TGW aged 15 to 19 in Latin America. Oral, anal, and urethral swabs were taken from 246 adolescents upon enrolment in the study to detect MG, MH, UU, and UP by quantitative polymerase chain reaction (qPCR). Bivariate and multivariate analyses were conducted by Poisson regression and 95% confidence intervals (95% CI) were estimated. RESULTS The prevalence of Mollicutes was 32.1%. UU was the most prevalent species (20.7%), followed by MH (13.4%), MG (5.7%), and UP (3.2%); 67.3% of the positive samples would have been missed if only urethral samples had been taken. Receptive anal sex (prevalence ratio [PR] = 1.79; 95% CI = 1.07-3.01) and clinical suspicion of sexually transmitted infection (PR = 1.62; 95% CI = 1.01-2.61) were factors associated with the detection of Mollicutes in general. Group sex (PR = 1.98; 95% CI = 1.12-3.50) and receptive anal sex (PR = 2.36; 95% CI = 0.95-5.86) were associated with the detection of Mycoplasma spp. No sociodemographic, clinical, or behavioural variable was significantly associated with the detection of Ureaplasma spp. CONCLUSIONS A high prevalence of Mollicutes was observed among adolescent MSM and TGW, especially at extragenital sites. Further research is required to understand the epidemiological profile of high-risk adolescents in different regions and contexts, and to investigate the pathogenesis of Mollicutes in the oral and anal mucosa before routine screening can be recommended in clinical practice.
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Affiliation(s)
- Valdiele de Jesus Salgado
- State University of Santa Cruz, Rod. Jorge Amado, Km 16, Salobrinho, Ilhéus, Bahia, 45662-900, Brazil
| | | | - Ágatha Morgana Bertoti da Silva
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Henrique Inácio Lima de Brito
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Danielle Souto de Medeiros
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Fabiane Soares
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
| | - Laio Magno
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
- Department of Life Sciences, State University of Bahia, Rua Silveira Martins, 2555, Salvador, Bahia, 41000-150, Brazil
| | - Inês Dourado
- Institute of Collective Health, Federal University of Bahia, Av. Adhemar de Barros, S/nº, Ondina, Salvador, Bahia, 40170-110, Brazil
| | - Guilherme Barreto Campos
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil
| | - Lucas Miranda Marques
- State University of Santa Cruz, Rod. Jorge Amado, Km 16, Salobrinho, Ilhéus, Bahia, 45662-900, Brazil.
- Multidisciplinary Health Institute, Federal University of Bahia, Rua Hormindo Barros, 58, Candeias, Vitória da Conquista, Bahia, 45029-094, Brazil.
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2
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Jensen JS, Cusini M, Gomberg M, Moi H, Wilson J, Unemo M. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2022; 36:641-650. [PMID: 35182080 DOI: 10.1111/jdv.17972] [Citation(s) in RCA: 72] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 01/07/2022] [Indexed: 12/27/2022]
Abstract
Mycoplasma genitalium infection contributes to 10-35% of non-chlamydial non-gonococcal urethritis in men. In women, M. genitalium is associated with cervicitis and pelvic inflammatory disease (PID) in 10-25%. Transmission of M. genitalium occurs through direct mucosal contact. CLINICAL FEATURES AND DIAGNOSTIC TESTS Asymptomatic infections are frequent. In men, urethritis, dysuria and discharge predominate. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. Symptoms are the main indication for diagnostic testing. Diagnosis is achievable only through nucleic acid amplification testing and must include investigation for macrolide resistance mutations. THERAPY Therapy for M .genitalium is indicated if M. genitalium is detected. Doxycycline has a cure rate of 30-40%, but resistance is not increasing. Azithromycin has a cure rate of 85-95% in macrolide-susceptible infections. An extended course of azithromycin appears to have a higher cure rate, and pre-treatment with doxycycline may decrease organism load and the risk of macrolide resistance selection. Moxifloxacin can be used as second-line therapy but resistance is increasing. RECOMMENDED TREATMENT Uncomplicated M. genitalium infection without macrolide resistance mutations or resistance testing: Azithromycin 500 mg on day one, then 250 mg on days 2-5 (oral). Second-line treatment and treatment for uncomplicated macrolide-resistant M. genitalium infection: Moxifloxacin 400 mg od for 7 days (oral). Third-line treatment for persistent M. genitalium infection after azithromycin and moxifloxacin: Doxycycline or minocycline 100 mg bid for 14 days (oral) may cure 40-70%. Pristinamycin 1 g qid for 10 days (oral) has a cure rate of around 75%. Complicated M. genitalium infection (PID, epididymitis): Moxifloxacin 400 mg od for 14 days. MAIN CHANGES FROM THE 2016 EUROPEAN M. GENITALIUM GUIDELINE Due to increasing antimicrobial resistance and warnings against moxifloxacin use, indications for testing and treatment have been narrowed to primarily involve symptomatic patients. The importance of macrolide resistance-guided therapy is emphasised.
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Affiliation(s)
- J S Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - M Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - H Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
| | - J Wilson
- Genitourinary Medicine and HIV, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Unemo
- WHO Collaborating Centre for Gonorrhoea and other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University Hospital, Örebro University, Örebro, Sweden
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Kenyon C, De Baetselier I, Vanbaelen T, Buyze J, Florence E. The Population-Level Effect of Screening for Mycoplasma genitalium on Antimicrobial Resistance: A Quasi-Experimental Study. Sex Transm Dis 2021; 48:629-634. [PMID: 34110732 DOI: 10.1097/olq.0000000000001404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND No studies have evaluated the utility and risks of screening for Mycoplasma genitalium in men who have sex with men taking preexposure prophylaxis (PrEP). We made use of a quasi-experimental design to evaluate the effect of screening for M. genitalium in a demonstration PrEP cohort with 3-monthly follow-up. METHODS We compared the proportion of PrEP participants with M. genitalium clearance, the duration of persistence, proportion with incident symptoms, the incidence of fluoroquinolone and macrolide resistance, and the proportion of noncleared infections with resistance-associated mutations between 2 groups: those in whom the first episode of M. genitalium was treated and those in whom it was not treated. RESULTS M. genitalium was detected in 70 of 179 individuals. The first episode of infection was treated in 46 individuals. Treatment was not significantly associated with the incidence of symptomatic infections or the acquisition of genotypic resistance. Treatment was associated with a higher probability of clearance of infection but at the expense of increasing the proportion of remaining infections that were resistant. In the nontreated group, the infections that did not clear were less likely to be fluoroquinolone resistant (1/6 [16.7%]) than those that did clear (4/4 [100%]; P = 0.048). In contrast, in the treated group, there was no significant difference in the proportion of fluoroquinolone resistance between the infections that persisted and cleared. CONCLUSIONS If screening and treatment increase the ratio of resistant to susceptible M. genitalium in a population, then this could play a role in the spread of antimicrobial resistance.
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Affiliation(s)
| | | | - Thibaut Vanbaelen
- From the HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Jozefien Buyze
- From the HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eric Florence
- From the HIV/STI Unit, Institute of Tropical Medicine, Antwerp, Belgium
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4
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Fernández-Huerta M, Serra-Pladevall J, Pumarola T, Pich OQ, Espasa M. Comment on: Lower mgpB diversity in macrolide-resistant Mycoplasma genitalium infecting men visiting two sexually transmitted infection clinics in Montpellier, France. J Antimicrob Chemother 2021; 76:1649-1650. [PMID: 33657213 DOI: 10.1093/jac/dkab041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Miguel Fernández-Huerta
- Microbiology Department, Vall d´Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain.,Microbiology Department, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain
| | - Judit Serra-Pladevall
- Microbiology Department, Vall d´Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Tomàs Pumarola
- Microbiology Department, Vall d´Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Oscar Q Pich
- Microbiology Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain.,Institute of Biotechnology and Biomedicine & Department of Biochemistry and Molecular Biology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mateu Espasa
- Microbiology Department, Corporació Sanitària Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain
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Shipitsyna E, Unemo M. A profile of the FDA-approved and CE/IVD-marked Aptima Mycoplasma genitalium assay (Hologic) and key priorities in the management of M. genitalium infections. Expert Rev Mol Diagn 2020; 20:1063-1074. [PMID: 33095669 DOI: 10.1080/14737159.2020.1842198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Mycoplasma genitalium (MG) causes frequently asymptomatic STIs. MG prevalence figures are lacking and management is complicated by the lack of etiological diagnostics and high antimicrobial resistance in many countries. Appropriately validated, quality-assured, and FDA-approved MG diagnostic assays have been lacking. AREAS COVERED The clinical and analytical performance characteristics of the Aptima® MG assay, the first FDA-approved MG nucleic acid amplification test (NAAT), are summarized. Key priorities in the management and control of MG infections are also discussed. EXPERT OPINION Highly sensitive, specific, and quality-assured MG NAATs, e.g. the Aptima MG assay on the automated and flexible Panther® platform, are imperative to improve the management and control of MG infections internationally. This testing, combined with macrolide-resistance testing (not yet available on the Panther platform), offers a rapid, high-throughput, and appropriate diagnosis of MG. Macrolide resistance-guided sequential treatment needs to be implemented for MG infections. Dual antimicrobial therapy, novel antimicrobials and, ideally, a vaccine may become essential.
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Affiliation(s)
- Elena Shipitsyna
- Department of Medical Microbiology, D.O. Ott Research Institute of Obstetrics, Gynecology and Reproductology , St. Petersburg, Russia
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University , Örebro, Sweden
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Broad CE, Furegato M, Harrison MA, Pond MJ, Tan N, Okala S, Fuller SS, Harding-Esch EM, Sadiq ST. High prevalence of coinfection of azithromycin-resistant Mycoplasma genitalium with other STIs: a prospective observational study of London-based symptomatic and STI-contact clinic attendees. Sex Transm Infect 2020; 97:63-68. [PMID: 32393529 DOI: 10.1136/sextrans-2019-054356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 03/24/2020] [Accepted: 04/14/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Azithromycin treatment of Chlamydia trachomatis (CT) may not be adequate to treat concomitant Mycoplasma genitalium (MG) infection, and particularly if MG has macrolide resistance-associated mutations (MG-MRAMs). We estimated prevalence of coinfections of CT with MG carrying MRAM, and risk factors for MG-MRAM among a sexual health clinic population. STUDY DESIGN AND SETTING Among symptomatic and STI-contact clinic attendees in London, prevalence of CT-MG coinfection and MG-MRAM were estimated using nucleic acid amplification testing and Sanger sequencing, respectively, and their associated risk factors analysed using logistic regression. RESULTS MG prevalence was 7.5% (23/307), 17.3% (30/173), and 11.4% (8/70) in females, men who have sex with women (MSW) and men who have sex with men (MSM), respectively; MG coinfection in CT-infected participants represented 28.0% (7/25), 13.5% (5/37), 0.0% (0/0), respectively. Presence of MG-MRAM was 39.1% (9/23) in female swabs, 70.0% (21/30) in MSW urine and 83.3% (5/6) in MSM rectal swabs. In multivariate analyses, coinfection with another STI was strongly associated with MG-MRAM (OR: 7.19; 95% CI: 2.4 to 21.5). CONCLUSION A significant proportion of participants in our study of symptomatic patients and STI contacts were infected with macrolide-resistant MG, suggesting that testing for MG and MRAM, for MG positives, might be clinically useful. The findings also suggest services explore potential benefits of testing CT positive samples for MG in these patient groups. Where MG testing is not available, potential high rates of MG coinfection should be borne in mind when considering azithromycin in the treatment of CT among STI contacts and symptomatic patients.
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Affiliation(s)
- Claire E Broad
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Martina Furegato
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK.,National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Mark A Harrison
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Marcus J Pond
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - NgeeKeong Tan
- Southwest London Pathology, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sandra Okala
- National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - Sebastian S Fuller
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Emma M Harding-Esch
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK.,National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK
| | - S Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK .,National Infection Service, Public Health England, Colindale, London, NW9 5EQ, UK.,St George's University Hospitals NHS Foundation Trust, London, UK
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7
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Single-Locus-Sequence-Based Typing of the mgpB Gene Reveals Transmission Dynamics in Mycoplasma genitalium. J Clin Microbiol 2020; 58:JCM.01886-19. [PMID: 31941694 DOI: 10.1128/jcm.01886-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 01/11/2020] [Indexed: 11/20/2022] Open
Abstract
Sexually transmitted infections (STIs) by Mycoplasma genitalium are a major problem worldwide, especially given their marked and rapid propensity for developing antimicrobial resistance. Since very few treatment options exist, clinicians face an important challenge in the management of the infection. In this scenario, little is known regarding the transmission dynamics of M. genitalium and the epidemiology of antimicrobial resistance. This mgpB-based molecular typing study, conducted among 54 asymptomatically infected individuals prospectively recruited from an STI screening service, reveals two distinct epidemiological clusters that significantly correlate with sexual conduct in heterosexuals and men who have sex with men (MSM), respectively. This well-defined structuration suggests the presence of two independent sexual networks with little connectivity between them. On the other hand, the study demonstrates the multiclonal feature of the emergence of antibiotic resistance in M. genitalium to both macrolides and fluoroquinolones. The high prevalence of macrolide resistance in M. genitalium among MSM, influenced by dense network connectivity and strong antibiotic selective pressure, may correspond to allodemics affecting other STIs such as gonorrhea, syphilis and enteric pathogens. Collaterally, the structural and functional impact of mutations in the mgpB gene, encoding the major adhesin P140 (MgpB), may require further investigation.
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8
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De Carvalho NS, Palú G, Witkin SS. Mycoplasma genitalium, a stealth female reproductive tract. Eur J Clin Microbiol Infect Dis 2019; 39:229-234. [PMID: 31522281 DOI: 10.1007/s10096-019-03707-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 09/06/2019] [Indexed: 10/26/2022]
Abstract
Mycoplasma genitalium was first isolated from the urethral swabs of two symptomatic men with urethritis in 1980. It is a sexually transmitted bacterium associated with a number of urogenital conditions in women like cervicitis, endometritis, pelvic inflammatory disease, infertility, and susceptibility to human immunodeficiency virus (HIV). However, M. genitalium may also act like a stealth pathogen at female reproductive tract, giving no symptoms. Its prevalence varies between different groups, with the average being 0.5-10% in the general population and 20-40% in women with sexually transmitted infections. The recommended treatment of this infection is azithromycin as a single 1-g dose. However, in recent years, macrolide resistance has increased which is significantly lowering the cure rate, being less than 50% in some studies. New treatment regimens need to be investigated due to increasing drug resistance. The discussion and suggestion of an algorithm for management of this infection is the highlight of this paper.
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Affiliation(s)
- Newton Sergio De Carvalho
- Obstetrics and Gynecology Department of Federal University of Paraná (DTG/UFPR), Gynecology and Obstetrics Infections Sector from Clinical Hospital - UFPR, Rua Saldanha Marinho 1422 - 801, Curitiba, Paraná, CEP 80430-160, Brazil.
| | - Gabriele Palú
- Obstetrics and Gynecology Department of Federal University of Paraná (DTG/UFPR), Gynecology and Obstetrics Infections Sector from Clinical Hospital - UFPR, Rua Saldanha Marinho 1422 - 801, Curitiba, Paraná, CEP 80430-160, Brazil
| | - Steven S Witkin
- Division of Immunology and Infectious Diseases, Department of Obstetrics and Gynecology, Weill Cornell Medicine, New York, NY, USA
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Soni S, Horner P, Rayment M, Pinto-Sander N, Naous N, Parkhouse A, Bancroft D, Patterson C, Fifer H. British Association for Sexual Health and HIV national guideline for the management of infection with Mycoplasma genitalium (2018). Int J STD AIDS 2019; 30:938-950. [DOI: 10.1177/0956462419825948] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This is the first British Association for Sexual Health and HIV (BASHH) guideline for the diagnosis and management of Mycoplasma genitalium in people aged 16 years and older. The guideline is primarily aimed at level 3 sexually transmitted infection (STI) management services within the UK, although it could also serve as a reference guide for STI services at other levels.
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Affiliation(s)
| | - Paddy Horner
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | | | - Nadia Naous
- Imperial College Healthcare NHS Trust, London, UK
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10
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Couldwell DL, Jalocon D, Power M, Jeoffreys NJ, Chen SCA, Lewis DA. Mycoplasma genitalium: high prevalence of resistance to macrolides and frequent anorectal infection in men who have sex with men in western Sydney. Sex Transm Infect 2018; 94:406-410. [PMID: 29567802 DOI: 10.1136/sextrans-2017-053480] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/04/2018] [Accepted: 02/17/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We aimed to estimate the prevalence of Mycoplasma genitalium infection and of mutations linked to macrolide resistance using the ResistancePlus MG assay (SpeeDx, Sydney, New South Wales, Australia) in first-void urine (FVU), anorectal and oropharyngeal samples from men who have sex with men (MSM) attending Western Sydney Sexual Health Centre (WSSHC). METHODS Consecutive symptomatic and asymptomatic MSM attending for STI testing were prospectively enrolled. M. genitalium testing using the ResistancePlus MG assay was performed on FVU, anorectal and oropharyngeal samples routinely collected for Chlamydia trachomatis and Neisseria gonorrhoeae assays. RESULTS Overall, the prevalence of M. genitalium infection in the study group was 13.4% (68/508). Most (79.4%, 54/68) M. genitalium harboured macrolide resistance mutations (87.5% of urethral and 75.6% of anorectal infections). The anorectum was the most commonly infected site (45/505, 8.9%), followed by the urethra (24/508, 4.7%). No oropharyngeal M. genitalium infections were detected (0/508). Most of the anorectal (93.3%) and urethral (79.2%) infections were asymptomatic.MSM who were taking HIV pre-exposure prophylaxis (PrEP) were twice as likely to be infected with M. genitalium compared with MSM who were not on PrEP (OR 2.1, 95% CI 1.3 to 3.6; P=0.0041). Always using condoms for anal sex in the last 3 months was protective of infection (OR 0.8, 95% CI 0.6 to 1.0; P=0.0186). CONCLUSIONS We demonstrated a high prevalence of M. genitalium and very high levels of macrolide resistance among MSM attending WSSHC. Our findings support the routine use of an assay to detect macrolide resistance mutations in M. genitalium infections. This will ensure, in regions or populations with high rates of macrolide resistance among M. genitalium strains, that first-line treatment with azithromycin will only be used if a macrolide-sensitive strain is identified.
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Affiliation(s)
- Deborah L Couldwell
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia
| | - Dean Jalocon
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Melissa Power
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
| | - Neisha J Jeoffreys
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead, New South Wales, Australia
| | - Sharon C-A Chen
- Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia.,Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, NSW Health Pathology, Westmead, New South Wales, Australia
| | - David A Lewis
- Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity and Sydney Medical School-Westmead, University of Sydney, Sydney, New South Wales, Australia
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Clutterbuck D, Asboe D, Barber T, Emerson C, Field N, Gibson S, Hughes G, Jones R, Murchie M, Nori AV, Rayment M, Sullivan A. 2016 United Kingdom national guideline on the sexual health care of men who have sex with men. Int J STD AIDS 2018:956462417746897. [PMID: 29334885 DOI: 10.1177/0956462417746897] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.
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Affiliation(s)
| | - David Asboe
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Tristan Barber
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Nigel Field
- 4 Public Health England, London, UK
- 5 University College London, London, UK
| | | | | | - Rachael Jones
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | | | - Achyuta V Nori
- 8 8945 Guy's and St Thomas' NHS Foundation Trust , London, UK
| | - Michael Rayment
- 2 Chelsea and Westminster Healthcare NHS Foundation Trust, London, UK
| | - Ann Sullivan
- 9 BASHH CEG, BASHH 2017 Registered Office, Macclesfield, UK
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12
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Sethi S, Zaman K, Jain N. Mycoplasma genitalium infections: current treatment options and resistance issues. Infect Drug Resist 2017; 10:283-292. [PMID: 28979150 PMCID: PMC5589104 DOI: 10.2147/idr.s105469] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Mycoplasma genitalium is one of the important causes of non-gonococcal urethritis. Rising incidence and emerging antimicrobial resistance are a major concern these days. The poor clinical outcomes with doxycycline therapy led to the use of azithromycin as the primary drug of choice. Single-dose azithromycin regimen over a period of time was changed to extended regimen following studies showing better clinical cures and less risk of resistance development. However, emerging macrolide resistance, either due to transmission of resistance or drug pressure has further worsened the management of this infection. The issues of drug resistance and treatment failures also exist in cases of M. genitalium infection. At present, the emergence of multidrug-resistant (MDR) M. genitalium strains is an alarming sign for its treatment and the associated public health impact due to its complications. However, newer drugs like pristinamycin, solithromycin, sitafloxacin, and others have shown a hope for the clinical cure, but need further clinical trials to optimize the therapeutic dosing schedules and formulate appropriate treatment regimens. Rampant and inappropriate use of these newer drugs will further sabotage future attempts to manage MDR strains. There is currently a need to formulate diagnostic algorithms and etiology-based treatment regimens rather than the syndromic approach, preferably using combination therapy instead of a monotherapy. Awareness about the current guidelines and recommended treatment regimens among clinicians and local practitioners is of utmost importance. Antimicrobial resistance testing and global surveillance are required to assess the efficacy of current treatment regimens and for guiding future research for the early detection and management of MDR M. genitalium infections.
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Affiliation(s)
- Sunil Sethi
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamran Zaman
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neha Jain
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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13
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Unemo M, Jensen JS. Antimicrobial-resistant sexually transmitted infections: gonorrhoea and Mycoplasma genitalium. Nat Rev Urol 2017; 14:139-152. [PMID: 28072403 DOI: 10.1038/nrurol.2016.268] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The emergence of antimicrobial resistance (AMR) is a major concern worldwide and already compromises treatment effectiveness and control of several bacterial sexually transmitted infections (STIs). Neisseria gonorrhoeae and Mycoplasma genitalium are evolving into so-called superbugs that can become resistant, both in vitro and clinically, to essentially all antimicrobials available for treatment, causing exceedingly difficult-to-treat or untreatable STIs and threatening global public health. Widespread AMR in these bacteria is likely to persist and even worsen in the future, owing to the high number of infections, widespread and uncontrolled use of antimicrobials, limited surveillance of AMR and clinical failures, as well as the extraordinary capacity of these bacteria to develop AMR. This development would not only result in an increased prevalence of N. gonorrhoeae and M. genitalium infections but also in a considerably increasing number of severe complications affecting reproductive health. To combat this threat, clinicians need to be aware of the current guidelines on diagnostic procedures, recommended treatment regimens, as well as therapeutic options for multidrug-resistant bacteria. AMR testing needs to be more frequently performed, inform treatment decisions and elucidate how AMRs compromise treatment effectiveness, guiding research for effective future therapies.
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Affiliation(s)
- Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and other Sexually Transmitted Infections, National Reference Laboratory for Pathogenic Neisseria, Department of Laboratory Medicine, Clinical Microbiology, Faculty of Medicine and Health, Örebro University, SE-701 85 Örebro, Sweden
| | - Jorgen S Jensen
- Department of Microbiology and Infection Control, Sexually Transmitted Infections, Research and Development, Statens Serum Institut, Artillerivej 5, DK-2300 Copenhagen S, Denmark
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14
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Jensen JS, Cusini M, Gomberg M, Moi H. Background review for the 2016 European guideline on Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2016; 30:1686-1693. [PMID: 27605499 DOI: 10.1111/jdv.13850] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/23/2016] [Indexed: 11/29/2022]
Abstract
Mycoplasma genitalium is a cause of 10-35% of non-chlamydial non-gonococcal urethritis in men and in women, and is associated with cervicitis and pelvic inflammatory disease (PID). Transmission of M. genitalium occurs through direct mucosal contact. In women, symptoms include vaginal discharge, dysuria or symptoms of PID - abdominal pain and dyspareunia. In men, urethritis, dysuria and discharge predominates. Asymptomatic infections are frequent. In this review, we present the evidence base for the recommendations in the 2016 European guideline on M. genitalium infections and describe indications for testing, recommended diagnostic methods, treatment and patient management. The guideline was prepared on behalf of the European branch of The International Union against Sexually Transmitted Infections; the European Academy of Dermatology and Venereology; the European Dermatology Forum; the European Society of Clinical Microbiology and Infectious Diseases; the Union of European Medical Specialists. The European Centre for Disease Prevention and Control and the European Office of the World Health Organisation also contributed to their development.
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Affiliation(s)
- J S Jensen
- Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
| | - M Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology, Moscow, Russia
| | - H Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Oslo, Norway
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15
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Jensen J, Cusini M, Gomberg M, Moi H. 2016 European guideline on Mycoplasma genitalium
infections. J Eur Acad Dermatol Venereol 2016; 30:1650-1656. [DOI: 10.1111/jdv.13849] [Citation(s) in RCA: 255] [Impact Index Per Article: 31.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/23/2016] [Indexed: 11/30/2022]
Affiliation(s)
- J.S. Jensen
- Microbiology and Infection Control; Statens Serum Institut; Copenhagen Denmark
| | - M. Cusini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico; Milan Italy
| | - M. Gomberg
- Moscow Scientific and Practical Centre of Dermatovenereology and Cosmetology; Moscow Russia
| | - H. Moi
- Olafia Clinic; Oslo University Hospital; Institute of Medicine; University of Oslo; Oslo Norway
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16
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Horner P, Blee K, Adams E. Time to manage Mycoplasma genitalium as an STI: but not with azithromycin 1 g! Curr Opin Infect Dis 2014; 27:68-74. [PMID: 24322592 DOI: 10.1097/qco.0000000000000030] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mycoplasma genitalium is a sexually transmitted infection that causes significant morbidity in men and women and is a co-factor in HIV transmission. However, commercial diagnostic tests are not generally available for M. genitalium and sub-optimal treatment is often given. We review the literature on the burden of infection, how it may present in clinical practice and the effectiveness of current treatment regimens. RECENT FINDINGS In-vivo and in-vitro data strongly suggest that M. genitalium is an important cause of urethritis, cervicitis, pelvic inflammatory disease and potentially asymptomatic proctitis. Studies now consistently demonstrate suboptimal eradication rates with the current treatment regimens recommended first line for the treatment of nongonococcal urethritis. Concurrently, there has been a rapid emergence of antibiotic resistance in M. genitalium, with macrolide resistance now appearing to be endemic in some centres, and quinolone resistance is beginning to emerge. SUMMARY In the absence of specific M. genitalium diagnostic and antimicrobial resistance testing, azithromycin 1 g should not be used for the management of patients with symptomatic disease potentially caused by M. genitalium. This review offers an alternative evidence-based approach to managing such patients that should, theoretically, reduce the risk of the development of antimicrobial resistance.
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Affiliation(s)
- Patrick Horner
- aSchool of Social and Community Medicine, University of Bristol, UK bBristol Sexual Health Centre, University Hospitals Bristol NHS Foundation Trust, Tower Hill, Bristol cAquarius Population Health, London, UK
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17
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Templeton DJ, Read P, Varma R, Bourne C. Australian sexually transmissible infection and HIV testing guidelines for asymptomatic men who have sex with men 2014: a review of the evidence. Sex Health 2014; 11:217-29. [DOI: 10.1071/sh14003] [Citation(s) in RCA: 74] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 02/09/2014] [Indexed: 01/07/2023]
Abstract
Men who have sex with men (MSM) in Australia and overseas are disproportionately affected by sexually transmissible infections (STIs), including HIV. Many STIs are asymptomatic, so regular testing and management of asymptomatic MSM remains an important component of effective control. We reviewed articles from January 2009–May 2013 to inform the 2014 update of the 2010 Australian testing guidelines for asymptomatic MSM. Key changes include: a recommendation for pharyngeal chlamydia (Chlamydia trachomatis) testing, use of nucleic acid amplification tests alone for gonorrhoea (Neisseria gonorrhoeae) testing (without gonococcal culture), more frequent (up to four times a year) gonorrhoea and chlamydia testing in sexually active HIV-positive MSM, time required since last void for chlamydia first-void urine collection specified at 20 min, urethral meatal swab as an alternative to first-void urine for urethral chlamydia testing, and the use of electronic reminders to increase STI and HIV retesting rates among MSM.
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18
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de Vries HJC, Zingoni A, White JA, Ross JDC, Kreuter A. 2013 European Guideline on the management of proctitis, proctocolitis and enteritis caused by sexually transmissible pathogens. Int J STD AIDS 2013; 25:465-74. [PMID: 24352129 DOI: 10.1177/0956462413516100] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/21/2013] [Indexed: 11/17/2022]
Abstract
Proctitis is defined as an inflammatory syndrome of the distal 10-12 cm of the anal canal, also called the rectum. Infectious proctitis can be sexually transmitted via genital-anal mucosal contact, but some also via mutual masturbation.N. gonorrhoeae,C. trachomatis(including lymphogranuloma venereum), Herpes Simplex Virus andT. pallidumare the most common sexually transmitted anorectal pathogens. Shigellosis can be transferred via oral-anal contact and may lead to proctocolitis or enteritis. Although most studies on these infections have concentrated on men who have sex with men (MSM), a significant proportion of women have anal intercourse and therefore may also be at risk. A presumptive clinical diagnosis of proctitis can be made when there are symptoms and signs, and a definitive diagnosis when the results of laboratory tests are available. The symptoms of proctitis include anorectal itching, pain, cramps (tenesmus) and discharge in and around the anal canal. Asymptomatic proctitis occurs frequently and can only be detected by laboratory tests. The majority of rectal chlamydia and gonococcal infections are asymptomatic. Therefore when there is a history of receptive anal contact, exclusion of anorectal infections is generally indicated as part of standard screening for sexually transmitted infections (STIs). Condom use does not guarantee protection from bacterial and protozoan STIs, which are often spread without penile penetration.
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Affiliation(s)
- Henry J C de Vries
- STI outpatient clinic, Cluster Infectious Diseases, Health Service Amsterdam, Amsterdam, The Netherlands Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands Centre for Infectious Diseases and Immunology Amsterdam (CINIMA), Amsterdam, The Netherlands Centre for Infectious Disease Control, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Adele Zingoni
- Department of Biomedical Sciences and Human Oncology, Dermatologic Clinic, University of Turin, Turin, Italy
| | - John A White
- Department of Genitourinary Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D C Ross
- Sexual Health Clinic - University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Birmingham, UK
| | - Alexander Kreuter
- Department of Dermatology, Venereology, and Allergology, HELIOS St. Elisabeth Hospital Oberhausen, Germany
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19
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Abstract
This article summarizes the epidemiologic evidence linking Mycoplasma genitalium to sexually transmitted disease syndromes, including male urethritis, and female cervicitis, pelvic inflammatory disease, infertility, and adverse birth outcomes. It discusses the relationship of this bacterium to human immunodeficiency virus infection and reviews the available literature on the efficacy of standard antimicrobial therapies against M genitalium.
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Affiliation(s)
- Lisa E Manhart
- Department of Epidemiology, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA.
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