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Shah S, Kumar B, Narang T. Letter to the editor regarding "Laboratory detection of bacterial pathogens and clinical and laboratory response of syndromic management in patients with cervical discharge: A retrospective study". Indian J Dermatol Venereol Leprol 2024; 90:256-257. [PMID: 38595021 DOI: 10.25259/ijdvl_913_2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 12/09/2023] [Indexed: 04/11/2024]
Affiliation(s)
- Shikha Shah
- Department of Dermatology, PGIMER, Chandigarh, India
| | - Bhushan Kumar
- Department of Dermatology, Shalby Hospital, Punjab, India
| | - Tarun Narang
- Department of Dermatology, PGIMER, Chandigarh, India
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Wang Z, Xia M, Chen Y, Yang Z, Yi J, Kong L, Zhang H, Luo G, Li R, Dou Y. Prevalence of Ureaplasma species among patients at a tertiary hospital in China: a 10-year retrospective study from 2013 to 2022. Eur J Clin Microbiol Infect Dis 2023; 42:1425-1437. [PMID: 37843646 DOI: 10.1007/s10096-023-04678-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/03/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Ureaplasma species are common pathogens of the urogenital tract and can cause a range of diseases. Unfortunately, there is still a scarcity of large-scale and cross-sectional studies on the prevalence of Ureaplasma species in China to clarify their epidemic patterns. METHODS This study retrospectively analyzed the data of 18667 patients who visited Peking Union Medical College Hospital for showing various symptoms of (suspected) Ureaplasma species infection during the period 2013-2022. The overall prevalence of Ureaplasma species was calculated, and subgroup analyses were conducted in view of gender, age, specimen types, and diagnosis in every year within the period studied. Furthermore, previous literature that reported on the prevalence of Ureaplasma species in various regions of China was searched and summarized. RESULTS The overall positive rate of Ureaplasma species in this study reached 42.1% (7861/18667). Specifically, the prevalence of Ureaplasma species was significantly higher in female patients, while the highest detection rate was found in the 21-50 age group. From 2013 to 2022, there were no significant differences in positive rates of Ureaplasma species among years. However, the detection rate of Ureaplasma species was decreased in COVID-19 period (2020-2022) compared to pre-COVID-19 period (2017-2019). In view of the distribution of patients, outpatients predominated, but the detection rate was lower than inpatients. Urine was the most common specimen type, while cervical swabs had the highest detection rate of Ureaplasma species. When grouped by diagnosis, the highest positive rate of Ureaplasma species was seen in patients with adverse pregnancy outcomes and the lowest rate in patients with prostate disease. The previous literature, although heterogeneous, collectively suggested a high prevalence of Ureaplasma species in China. CONCLUSIONS Our study has shown that Ureaplasma species have reached a significant prevalence in China and demands adequate attention.
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Affiliation(s)
- Ziran Wang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Mingqi Xia
- Department of Education, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yu Chen
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Zhuo Yang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jie Yi
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Lingjun Kong
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Han Zhang
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Guoju Luo
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Rui Li
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yaling Dou
- Department of Clinical Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China.
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Kang WT, Xu H, Liao Y, Guo Q, Huang Q, Xu Y, Li Q. Qualitative and Quantitative Detection of Multiple Sexually Transmitted Infection Pathogens Reveals Distinct Associations with Cervicitis and Vaginitis. Microbiol Spectr 2022; 10:e0196622. [PMID: 36314938 PMCID: PMC9769840 DOI: 10.1128/spectrum.01966-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/05/2022] [Indexed: 11/07/2022] Open
Abstract
Many diverse pathogens have been discovered from reproductive-tract infections, but the relationship between the presence and abundance of particular pathogen species and disease manifestations is poorly defined. The present work examined the association of multiple common pathogens causing sexually transmitted infections (STIs) with cervicitis and vaginitis. The presence and abundance of 15 STI pathogens and the genotypes of human papillomavirus were determined in a cohort of 944 women that included 159 cervicitis patients, 207 vaginitis patients, and 578 healthy controls. Logistic regression and random forest models were constructed and validated in a separate cohort of 420 women comprising 52 cervicitis patients, 109 vaginitis patients, and 259 healthy controls. The frequency of individual STI pathogen species varied among the symptomatic patients and healthy controls. Abundance determination was necessary for most pathogens that were associated with the studied diseases. STI pathogens were more commonly associated with cervicitis than with vaginitis. Pathogen identification- and quantification-based diagnosis was observed for cervicitis with high sensitivity and specificity, but for vaginitis, the assay results would need to be combined with results of other diagnostic tests to firmly establish the pathogen-disease correlation. Integrated qualitative and quantitative detection of a selected panel of common STI pathogens can reveal their association with cervicitis and vaginitis. STI pathogen identification and quantification can be used to diagnose cervicitis and also help improve correct diagnosis of vaginitis. IMPORTANCE Scarce information exists with regard to whether STI pathogens can be defined as valid microbiological predictive markers for the diagnosis of cervicitis and vaginitis. We therefore conducted this study to assess the presence and abundance of a wide range of STI pathogens among patients having these two diseases and healthy controls as well. High sensitivity and specificity were observed for cervicitis by pathogen identification- and quantification-based diagnosis. In contrast, the assay results obtained for vaginitis would need to be combined with test results obtained by other diagnostic methods to decisively establish the pathogen-disease correlation. Simultaneous qualitative and quantitative detection of a selected panel of common STI pathogens and further coupling with machine learning models is worthwhile for establishing pathogen-based diagnosis of gynecological inflammations, which could be of great value in guiding the rational use of antimicrobials to control the spread of STIs.
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Affiliation(s)
- Wen-Tyng Kang
- Engineering Research Centre of Molecular Diagnostics, Ministry of Education, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Engineering Research Centre of Personalized Molecular Diagnostics of Xiamen, Xiamen, Fujian, China
| | - Haibo Xu
- Engineering Research Centre of Molecular Diagnostics, Ministry of Education, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Engineering Research Centre of Personalized Molecular Diagnostics of Xiamen, Xiamen, Fujian, China
| | - Yiqun Liao
- Engineering Research Centre of Molecular Diagnostics, Ministry of Education, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Engineering Research Centre of Personalized Molecular Diagnostics of Xiamen, Xiamen, Fujian, China
| | - Qiwei Guo
- Xiamen Maternal and Child Health Hospital, Xiamen, Fujian, China
- United Diagnostic and Research Center for Clinical Genetics, School of Public Health of Xiamen University, Xiamen, Fujian, China
| | - Qiuying Huang
- Engineering Research Centre of Molecular Diagnostics, Ministry of Education, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Engineering Research Centre of Personalized Molecular Diagnostics of Xiamen, Xiamen, Fujian, China
| | - Ye Xu
- Engineering Research Centre of Molecular Diagnostics, Ministry of Education, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Engineering Research Centre of Personalized Molecular Diagnostics of Xiamen, Xiamen, Fujian, China
| | - Qingge Li
- Engineering Research Centre of Molecular Diagnostics, Ministry of Education, State Key Laboratory of Cellular Stress Biology, School of Life Sciences, Xiamen University, Xiamen, Fujian, China
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
- Engineering Research Centre of Personalized Molecular Diagnostics of Xiamen, Xiamen, Fujian, China
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Carbone L, Conforti A, La Marca A, Cariati F, Vallone R, Raffone A, Buonfantino C, Palese M, Mascia M, DI Girolamo R, Capuzzo M, Esteves SC, Alviggi C. The negative impact of most relevant infections on fertility and assisted reproduction technology. Minerva Obstet Gynecol 2022; 74:83-106. [PMID: 34137567 DOI: 10.23736/s2724-606x.21.04870-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Infections may act with variable impact on the physiopathology of the reproductive organs, determining infertility or reducing the outcomes of assisted reproduction technology. The aim of this narrative review is to describe the existing evidence regarding the pathogens with a supposed or recognized role in reproductive medicine. Viral hepatitis, as well as HIV, can reduce sperm quality. Syphilis carries a risk of erectile dysfunction and increased endometrial thickness. Chlamydia is the main cause of pelvic inflammatory disease. In relation to Mycoplasma and Ureaplasma spp., only few species seem to show a correlation with infertility and poor in-vitro fertilization outcomes. There is evidence of a role for bacterial vaginosis in early pregnancy loss. HPV infection in males seems to determine infertility. Herpesviruses are more a risk for fetuses than for fertility itself. Zika virus is responsible for altered early embryo development and waiting to conceive is recommended in suspected or confirmed cases. The impact of SARS-CoV-2 is yet to be elucidated. Rubella and toxoplasmosis can provoke important congenital defects and therefore screening is mandatory before conception; a vaccine for Rubella is recommended. Further and well-designed studies are still needed to better elucidate the role of some infectious agents, to improve fertility and its treatments.
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Affiliation(s)
- Luigi Carbone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy -
| | - Alessandro Conforti
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio La Marca
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Roberta Vallone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Antonio Raffone
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Cira Buonfantino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Michela Palese
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Marika Mascia
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
| | - Raffaella DI Girolamo
- Center for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - Martina Capuzzo
- Department of Medical and Surgical Sciences for Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Sandro C Esteves
- Division of Urology, Department of Surgery, University of Campinas (UNICAMP), Campinas, Brazil
- Faculty of Health, Aarhus University, Aarhus, Denmark
- ANDROFERT - Andrology and Human Reproduction Clinic, Campinas, Brazil
| | - Carlo Alviggi
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples Federico II, Naples, Italy
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Salmanov AG, Koctjuk IM, Ihnatieva OK, Vitiuk AD, Artyomenko V, Paliga I, Suslikova LV. PREVALENCE OF HEALTHCARE-ASSOCIATED CERVICITIS AND ANTIMICROBIAL RESISTANCE OF THE RESPONSIBLE PATHOGENS IN UKRAINE: RESULTS OF A MULTICENTER STUDY (2019-2021). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2189-2197. [PMID: 36378693 DOI: 10.36740/wlek202209202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To obtain the first estimates of the current prevalence of healthcare-associated cervicitis (HACs) and antimicrobial resistance of responsible pathogens in Ukraine. PATIENTS AND METHODS Materials and methods: We conducted a retrospective multicentre cohort study was based on surveillance data from January 1st, 2019 to December 31st, 2021 in Ukraine. Antibiotic susceptibility testing was determined by Kirby-Bauer disc diffusion test according to the protocol of the European Committee on Antimicrobial Susceptibility Testing. RESULTS Results: Of the 6,885 participants in this study, 1746 women (25.5%) met the clinical definition of cervicitis. Prevalence of HACs and cervcits caused sexually transmitted pathogens were 12.7% and 8.3%, respectively. The incidence of HACs among women with a history of gynecological procedures was 25.4%. The main causes of HACs were legal induced abortions (28.8%), vaginal hysterectomy (23.9%), and postpartum instrumental examination (12.8%). The predominant pathogens of HACs were: Escherichia coli, Enterobacter spp., Klebsiella spp., Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis. Methicillin-resistance was observed in 20.8% of S. aureus (MRSA). Vancomycin resistance was observed in 7.4% of isolated enterococci (VRE). Resistance to third-generation cephalosporins was observed in 13.1% Klebsiella spp. and E.coli 17.5% isolates. Carbapenem resistance was identified in 11.6% of P.aeruginosa isolates. The prevalence of ESBL production among E. coli isolates was significantly higher than in K. pneumoniae (33.5%, vs 8.7%). The overall proportion of extended spectrum beta-lactamases (ESBL) production among Enterobacteriaceae was 34.6%. CONCLUSION Conclusions: This study showed that the prevalence of healthcare-associated cervicitis in Ukraine is high, and many cases were caused by antibiotic-resistant pathogens.
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Affiliation(s)
- Aidyn G Salmanov
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE; NATIONAL ACADEMY OF MEDICAL SCIENCES OF UKRAINE, KYIV, UKRAINE
| | - Irina M Koctjuk
- NATIONAL PIROGOV MEMORIAL MEDICAL UNIVERSITY, VINNYTSIA, UKRAINE
| | | | - Alla D Vitiuk
- SHUPYK NATIONAL HEALTHCARE UNIVERSITY OF UKRAINE, KYIV, UKRAINE
| | | | - Ihor Paliga
- ANDREI KRUPYNSKYI LVIV MEDICAL ACADEMY, LVIV, UKRAINE
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Tandon D, Patil AD, Pramanik JM, Kerkar S, Munne K, Begum S, Tryambake V, Surve S. Cross sectional study to evaluate microbiological spectrum of RTI/STI and co-infections among women with cervicitis or cervico-vaginitis from a community clinic in Mumbai. Indian J Med Microbiol 2021; 40:144-146. [PMID: 34772538 DOI: 10.1016/j.ijmmb.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 09/22/2021] [Accepted: 10/07/2021] [Indexed: 11/27/2022]
Abstract
Cervicitis is an inflammatory condition of cervix, when presented along with vaginal discharge; it is termed as cervico-vaginitis. These can be infective, hence important to diagnose due to risk of spreading to upper genital tract. This cross-sectional study was undertaken to evaluate the microbiological spectrum in cervicitis or cervico-vaginitis among 100 sexually active women by Gram stain and Multiplex Real time polymerase chain reaction. Bacterial vaginosis 21(21%) was the most common RTI. Among STIs, genital mycoplasmas were the predominant infections hence further research is required to understand their pathogenesis.
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Affiliation(s)
- Deepti Tandon
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India.
| | - Anushree D Patil
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India
| | - Jayanti Mania Pramanik
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India.
| | - Shilpa Kerkar
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India.
| | - Kiran Munne
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India.
| | - Shahina Begum
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India.
| | - Varsha Tryambake
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India.
| | - Suchitra Surve
- ICMR- National Institute for Research in Reproductive Health (NIRRH), J.M. Street, Parel, Mumbai, 400012, India
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Huang Y, Pan H, Xu X, Lv P, Wang X, Zhao Z. Droplet digital PCR (ddPCR) for the detection and quantification of Ureaplasma spp. BMC Infect Dis 2021; 21:804. [PMID: 34380416 PMCID: PMC8359095 DOI: 10.1186/s12879-021-06355-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 06/18/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Ureaplasma spp. are associated with various infectious diseases in females, but there is still limited evidence regarding whether they are related to nonspecific cervicitis. The aim of this study was to develop and evaluate a digital droplet PCR (ddPCR) assay for the detection and quantification of Ureaplasma spp. in cervical swabs. METHODS A total of 267 non-specific cervicitis (NSC) patients and 195 asymptomatic females were included in this study. We produced standard curves for Ureaplasma spp. to evaluate the analytical performance of the ddPCR assay. Then, we detected and quantified the bacterial load of Ureaplasma spp. in cervical swabs. RESULTS The prevalences of U. parvum were 37.8% (101/267) and 29.7% (58/195), U. urealyticum were 9.0% (24/267) and 8.7% (17/195) in the NSC group and control group, respectively. In addition, the median copy number of U. parvum was 2.5 × 104 copies/ml (n = 101) in the NSC group and 9.2 × 103 copies/ml (n = 58) in the control group. The U. parvum load in the NSC group was significantly higher than that in the asymptomatic individuals (P < 0.001). whereas the median load of U. urealyticum was 8.4 × 103 copies/ml (n = 24) and 1.4 × 103 (n = 17) copies/ml in the two groups, respectively, , the difference was not statistically significant (P = 0.450). CONCLUSIONS Our study is the first to develop a droplet digital PCR (ddPCR) method for the detection and quantification of Ureaplasma spp. in clinical samples, and the method has excellent analytical performance and a wide range of clinical application prospects.
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Affiliation(s)
- Yanfang Huang
- Clinical Laboratory, Minhang Hospital, Fudan University, No. 170, Xinsong Road, Shanghai, China
| | - Huifen Pan
- Clinical Laboratory, Minhang Hospital, Fudan University, No. 170, Xinsong Road, Shanghai, China
| | - Xiaoqin Xu
- Clinical Laboratory, Minhang Hospital, Fudan University, No. 170, Xinsong Road, Shanghai, China
| | - Panpan Lv
- Clinical Laboratory, Minhang Hospital, Fudan University, No. 170, Xinsong Road, Shanghai, China
| | - Xinxin Wang
- Department of Molecular Medicine, Biomed-Union Co. Ltd. Shanghai, Shanghai, China
| | - Zhen Zhao
- Clinical Laboratory, Minhang Hospital, Fudan University, No. 170, Xinsong Road, Shanghai, China.
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Workowski KA, Bachmann LH, Chan PA, Johnston CM, Muzny CA, Park I, Reno H, Zenilman JM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep 2021; 70:1-187. [PMID: 34292926 PMCID: PMC8344968 DOI: 10.15585/mmwr.rr7004a1] [Citation(s) in RCA: 750] [Impact Index Per Article: 250.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
These guidelines for the treatment of persons who have or are at risk for
sexually transmitted infections (STIs) were updated by CDC after consultation
with professionals knowledgeable in the field of STIs who met in Atlanta,
Georgia, June 11–14, 2019. The information in this report updates the
2015 guidelines. These guidelines discuss 1) updated recommendations for
treatment of Neisseria gonorrhoeae, Chlamydia trachomatis,
and Trichomonas vaginalis; 2) addition of
metronidazole to the recommended treatment regimen for pelvic inflammatory
disease; 3) alternative treatment options for bacterial vaginosis; 4) management
of Mycoplasma genitalium; 5) human papillomavirus vaccine
recommendations and counseling messages; 6) expanded risk factors for syphilis
testing among pregnant women; 7) one-time testing for hepatitis C infection; 8)
evaluation of men who have sex with men after sexual assault; and 9) two-step
testing for serologic diagnosis of genital herpes simplex virus. Physicians and
other health care providers can use these guidelines to assist in prevention and
treatment of STIs.
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Lillis RA, Martin DH, Nsuami MJ. Mycoplasma genitalium Infections in Women Attending a Sexually Transmitted Disease Clinic in New Orleans. Clin Infect Dis 2020; 69:459-465. [PMID: 30351348 DOI: 10.1093/cid/ciy922] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium has been significantly and nonsignificantly associated with cervicitis, urethritis, or vaginal discharge. This study examined the associations of M. genitalium with selected sexually transmitted infections (STIs) and demographic, behavioral, and clinical factors among women attending a sexually transmitted disease (STD) clinic in New Orleans. METHODS Women aged ≥18 years who presented to the New Orleans STD clinic provided sociodemographic data and sexual behavior; STI, obstetric, and gynecologic history; and urine, vaginal, endocervical, and rectal specimens. Specimens were tested for M. genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma species, and yeast. Bacterial vaginosis (BV) was diagnosed by Nugent score, and cervicitis was defined as ≥30 polymorphonuclear leukocytes per high-power microscopic field on a cervical Gram stain or yellow mucopus on an endocervical swab. RESULTS Among 400 women studied, M. genitalium was independently significantly associated with age <25 years (P < .03) and with ≥2 sexual partners in the last 12 months (P < .003). Neisseria gonorrhoeae (adjusted odds ratio [AOR], 1.75; P = .103), C. trachomatis (AOR, 1.43; P = .247), and T. vaginalis (AOR, 1.60; P = .120) independently increased the odds of infection with M. genitalium. Controlling for other STIs and BV, there was a positive trend for M. genitalium to predict cervicitis (AOR, 3.18 [95% confidence interval, .99-10.2]; P = .05). CONCLUSIONS Mycoplasma genitalium in our study displayed the clinical features of C. trachomatis and N. gonorrhoeae, the 2 organisms that drive research agendas in diagnosis, treatment, and prevention of bacterial STIs.
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Affiliation(s)
- Rebecca A Lillis
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David H Martin
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - M Jacques Nsuami
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Cervical Cytology of Samples with Ureaplasma urealyticum, Ureaplasma parvum, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma hominis, and Neisseria gonorrhoeae Detected by Multiplex PCR. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7045217. [PMID: 32724807 PMCID: PMC7366191 DOI: 10.1155/2020/7045217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 05/08/2020] [Accepted: 05/08/2020] [Indexed: 11/18/2022]
Abstract
Introduction Despite increasing application of molecular diagnostic methods for the detection of sexually transmitted infections, the cytological findings in pap smears of patients with pathogens that can be identified only by PCR are not yet well described. The aim of this study was to describe the most common cytological features in cervical pap smears of patients with Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum detected by multiplex PCR. Methods Cervical samples for conventional and liquid-based cytology and for multiplex PCR were collected from women ranging from 23 to 54 years old, who underwent routine screening at a gynecological Unit. Results Multiplex PCR was positive in 36.2% of the samples: Ureaplasma parvum 14.9%, Chlamydia trachomatis 10.6%, Trichomonas vaginalis 10.6%, Mycoplasma hominis 8.5%, Ureaplasma urealyticum 4.2%, Neisseria gonorrhoeae 2.1%, and Mycoplasma genitalium (0). Multiple pathogens were observed in 12.8% of samples. Microscopic cervicitis (≥10 polymorphonuclear leukocytes/epithelial cell) and normal (predominantly lactobacillary) microbiota were the most frequent findings in the samples in which the pathogens were detected alone or in multiple infections, except for samples with Trichomonas vaginalis in which the coccobacillary microbiota was the most common. In samples with microscopic cervicitis and normal microbiota, those with at least one pathogen identified by multiplex PCR were significantly more frequent than those with no pathogen, 66.6% versus 33.3%. Conclusion Failure to identify an inflammatory agent in pap smear with intense neutrophil exudate may suggest the presence of Ureaplasma parvum, Ureaplasma urealyticum, Chlamydia trachomatis, or Trichomonas vaginalis. A remark on the intensity of inflammation should be made in the reports of cervical pap smears so that this cytological finding can be correlated with clinical and PCR results.
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Hanna J, Yassine R, El-Bikai R, Curran MD, Azar M, Yeretzian J, Skaf R, Afif C, Saber T, Itani S, Hubeish M, El Jisr T, Hamzeh F, El Chaar M. Molecular epidemiology and socio-demographic risk factors of sexually transmitted infections among women in Lebanon. BMC Infect Dis 2020; 20:375. [PMID: 32460721 PMCID: PMC7251815 DOI: 10.1186/s12879-020-05066-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) cause a major public health problem that affect both men and women in developing and developed countries. The aim of the study was to estimate the prevalence of 11 STIs among women who voluntarily participated in the study, while seeking gynecological checkup. The existence of an association between the presence of pathogens and symptoms and various sociodemographic risk factors was assessed. METHODS A total of 505 vaginal and cervical specimens were collected from women above 18 years of age, with or without symptoms related to gynecological infections. Nucleic acid was extracted and samples were tested by real-time PCR for the following pathogens: Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Ureaplasma urealyticum, Urealplasma parvum, Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma girerdii, Gardnerella vaginalis, Candida albicans and Human Papillomavirus (HPV). Positive HPV samples underwent genotyping using a microarray system. RESULTS Of the 505 samples, 312 (62%) were screened positive for at least one pathogen. Of these, 36% were positive for Gardnerella vaginalis, 35% for Ureaplasma parvum, 8% for Candida albicans, 6.7% for HPV, 4.6% for Ureaplasma urealyticum, 3.6% for Mycoplasma hominis, 2% for Trichomonas vaginalis, 0.8% for Chlamydia trachomatis, 0.4% for Mycoplasma girerdii, 0.2% for Mycoplasma genitalium and 0.2% for Neisseria gonorrhoeae. Lack of symptoms was reported in 187 women (37%), among whom 61% were infected. Thirty-four samples were HPV positive, with 17 high risk HPV genotypes (HR-HPV); the highest rates being recorded for types 16 (38%), 18 (21%) and 51 (18%). Out of the 34 HPV positives, 29 participants had HR-HPV. Association with various risk factors were reported. CONCLUSIONS This is the first study that presents data about the presence of STIs among women in Lebanon and the MENA region by simultaneous detection of 11 pathogens. In the absence of systematic STI surveillance in Lebanon, concurrent screening for HPV and PAP smear is warranted.
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Affiliation(s)
- Jessica Hanna
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Ruba Yassine
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Rana El-Bikai
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Martin D Curran
- Public Health England Clinical Microbiology Laboratory, Addenbrooke's Hospital, Cambridge, UK
| | - Mathilde Azar
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Joumana Yeretzian
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon
| | - Rana Skaf
- Faculty of Medicine, University of Balamand, Beirut, Lebanon.,Department of Obstetrics and Gynecology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Claude Afif
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | - Toufic Saber
- Faculty of Medicine, University of Balamand, Beirut, Lebanon
| | | | | | | | - Fadia Hamzeh
- National Institution of Social Care and Vocational Training, Beirut, Lebanon
| | - Mira El Chaar
- Faculty of Health Sciences, University of Balamand, P.O.Box 166378 Ashrafieh, Beirut, 1100-2807, Lebanon.
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12
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Güralp O, Bostancı A, Özerkman Başaran E, Schild-Suhren M, Kaya B. Evaluation of the prevalence of sexually transmitted bacterial pathogens in Northern Cyprus by nucleic acid amplification tests, and investigation of the relationship between these pathogens and cervicitis. Turk J Obstet Gynecol 2020; 16:242-248. [PMID: 32231855 PMCID: PMC7090263 DOI: 10.4274/tjod.galenos.2019.80269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 10/12/2019] [Indexed: 01/29/2023] Open
Abstract
Objective: To evaluate the prevalence of pathogens, Chlamydia trachomatis, Neisseria gonorrhea and Trichomonas vaginalis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma urealyticum, and Ureaplasma parvum in women via multiplex-polymerase chain reaction (PCR)-deoxyribonucleic acid (DNA). Materials and Methods: Cervical swabs of 273 women in reproductive age who underwent gynecologic examination in our outpatient clinic were evaluated using the multiplex-PCR-DNA method. The presence of cervicitis, contraceptive methods, marital status, and the number of partners were evaluated. Results: One hundred six (39%) of the 273 women had at least one bacterium, 25 women (9.8%) had two bacteria, and three women (1%) had three bacteria. U. urealyticum was the most frequently encountered bacterium (13.9%), followed by M. hominis (12.8%), U. parvum (12.4%), C. trachomatis (5.4%), M. genitalium (2.9%), N. gonorrhea (2.5%), and T. vaginalis (0.3%). Bacterial infection was detected more frequently in women aged <25 years, single, who had multiple partners, and clinically diagnosed with cervicitis. The cervicitis rate was 39% in our study. M. genitalium was significantly more frequent in women with cervicitis than in women without cervicitis (5.6 vs. 1.2%, p=0.005). C. trachomatis and N. gonorrhea, which are often associated with cervicitis, were comparable in women with and without cervicitis. Conclusion: Women with clinically diagnosed cervicitis or even with a normal-appearing cervix should be tested using multiplex-real-time PCR-nucleic-acidamplification tests on suspicion of such an infection. M. genitalium is an emerging bacterial agent for cervicitis along with C. trachomatis and N. gonorrhea.
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Affiliation(s)
- Onur Güralp
- Carl von Ossietzky Oldenburg University Faculty of Medicine, Obstetrics and Gynecology, Klinikum AöR, Oldenburg, Germany
| | - Ayşegül Bostancı
- Near East University Faculty of Medicine, Department of Molecular Biology and Genetics, Lefkosa-TRNC, Turkey
| | - Esra Özerkman Başaran
- Near East University Faculty of Medicine, Department of Molecular Biology and Genetics, Lefkosa-TRNC, Turkey
| | - Meike Schild-Suhren
- Carl von Ossietzky Oldenburg University Faculty of Medicine, Obstetrics and Gynecology, Klinikum AöR, Oldenburg, Germany
| | - Barış Kaya
- Near East University Faculty of Medicine, Department of Obstetrics and Gynecology, Nicosia, Northern Cyprus
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13
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Zhao F, Feng X, Lv P, Xu X, Zhao Z. Real-time PCR assay may be used to verify suspicious test results of Ureaplasmas spp. from the liquid culture method. J Microbiol Methods 2020; 169:105831. [PMID: 31904441 DOI: 10.1016/j.mimet.2020.105831] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/01/2020] [Accepted: 01/01/2020] [Indexed: 11/16/2022]
Abstract
Ureaplasma spp. are associated with female genital tract infections and are mainly tested by liquid culture in developing countries. To evaluate the accuracy of liquid culture, 686 vaginal swabs were collected and tested by using the Mycoplasma Culturing, Identification, Enumeration, and Susceptibility (IES) Kit. Then these culture broths were verified using real-time PCR. Among 368 Ureaplasma positive broths, 263 contained Ureaplasma parvum, 30 contained Ureaplasma urealyticum, 57 contained both, and 18 were negative by real-time PCR. In 318 Ureaplasmas negative broths, 78 were found to be Ureaplasma positive by real-time PCR. Using real-time PCR as the reference, the false positive rate of the liquid culture was 7.0%. It has been suggested that the liquid culture positive broth should be inoculated onto solid agar to eliminate false-positives. However, solid culture is rarely used due to low sensitivity and being time consuming. Real-time PCR may be performed to replace solid culture to verify suspicious liquid culture results.
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Affiliation(s)
- Fang Zhao
- Clinical Laboratory, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Xiaojing Feng
- Clinical Laboratory, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200025, China
| | - Panpan Lv
- Clinical Laboratory, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Xiaoqin Xu
- Clinical Laboratory, Minhang Hospital, Fudan University, Shanghai 201199, China
| | - Zhen Zhao
- Clinical Laboratory, Minhang Hospital, Fudan University, Shanghai 201199, China.
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14
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Sanchez-Garcia EK, Contreras-Paredes A, Martinez-Abundis E, Garcia-Chan D, Lizano M, de la Cruz-Hernandez E. Molecular epidemiology of bacterial vaginosis and its association with genital micro-organisms in asymptomatic women. J Med Microbiol 2019; 68:1373-1382. [PMID: 31329097 DOI: 10.1099/jmm.0.001044] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Bacterial vaginosis (BV) is dysbiosis associated with an increased risk of several sexually transmitted infections. It is primarily diagnosed via Gram staining, although molecular analyses have presented higher diagnostic accuracy.Aim. This study aimed to evaluate the molecular epidemiology of BV in asymptomatic women to determine its association with several commensal and pathogenic micro-organisms of the genitalia.Methodology. The prevalence of BV was investigated through semiquantitative assessment of 201 women recruited during their routine gynaecological inspection at an outpatient clinic in Tabasco, Mexico.Results. Women with BV showed an increased prevalence of Chlamydia trachomatis (P=0.021) and Mycoplasma hominis (P=0.001). Of the BV-associated micro-organisms, Gardnerella vaginalis was significantly associated with C. trachomatis (P=0.005) and/or Ureaplasma parvum (P=0.003), whereas Atopobium vaginae and Megasphaera type 1 correlated significantly with Mycoplasma hominis (P=0.001). No significant association was observed between human papillomavirus (HPV) infection and BV, although there was increased prevalence of HPV59, HPV73, HPV52 and HPV58 in women displaying cervical cytological abnormalities.Conclusion. Identification of BV-associated micro-organisms via molecular analysis may help to distinguish recurrent cases from new infections and identify micro-organisms potentially associated with pharmacological resistance.
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Affiliation(s)
| | - Adriana Contreras-Paredes
- Unidad de Investigación Biomédica en Cancer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Eduardo Martinez-Abundis
- Division Academica Multidisciplinaria de Comalcalco, Universidad Juarez Autonoma de Tabasco, Magisterial, Mexico
| | - Dominga Garcia-Chan
- Unidad de Atencion Primaria de la Salud, Division Academica Multidisciplinaria de Comalcalco, Universidad Juarez Autonoma de Tabasco, 86205 Jalpa de Méndez, Mexico
| | - Marcela Lizano
- Unidad de Investigación Biomédica en Cancer, Instituto Nacional de Cancerología - Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Erick de la Cruz-Hernandez
- Division Academica Multidisciplinaria de Comalcalco, Universidad Juarez Autonoma de Tabasco, Magisterial, Mexico
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15
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Zanotta N, Campisciano G, Morassut S, Castro-Silva E, Luksa V, Zito G, Luppi S, Martinelli M, Colli C, De Seta F, Ricci G, Suligoi B, Comar M. Emerging role for Ureaplasma parvum serovar 3: Active infection in women with silent high-risk human papillomavirus and in women with idiopathic infertility. J Cell Physiol 2019; 234:17905-17911. [PMID: 30883747 DOI: 10.1002/jcp.28423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 12/17/2022]
Abstract
Recently, there are controversial opinions on the presence of Mycoplasmas/Ureaplasmas as colonizers or pathogens, and on the use of a targeted therapy. This study aimed to characterize Mycoplasmas/Ureaplasmas infections in reproductive age women, including the acquisition of sexually transmitted (ST) pathogens and poor birth outcomes. A total of 646 healthy Italian women fulfilled the inclusion criteria including 521 infertile women, 65 pregnant women, and 60 fertile women with identified risk factors and symptomatic for vaginitis/cervicitis. Multiplex and quantitative molecular techniques and direct automatic DNA sequencing were performed to assess the genome structure of Mycoplasma/Ureaplasma species and ST infected pathogens. Ureaplasma parvum serovar 3 represented the predominant colonizer of the urogenital tract of this series and the unique species significantly associated with ST pathogens coinfection (p < 0.01). U. parvum load >104 bacteria/ml, suggestive of active infection, has been measured only in asymptomatic high-risk human papillomavirus infected women (24.3%) and in 40% of women with idiopathic infertility. To note, 16% of the follicular fluid from these idiopathic women resulted infected with U. parvum. In conclusion, the present study focused the attention on U. parvum serovar 3 as emerging microorganism in sexually active women that may have the benefit of targeted therapy.
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Affiliation(s)
- Nunzia Zanotta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Sara Morassut
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Viviana Luksa
- Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Gabriella Zito
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Stefania Luppi
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | - Monica Martinelli
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
| | | | - Francesco De Seta
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Giuseppe Ricci
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
| | | | - Manola Comar
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.,Department of Medical Sciences, University of Trieste, Trieste, Italy
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16
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Ortiz-de la Tabla V, Gutiérrez F. Cervicitis: Etiology, diagnosis and treatment. Enferm Infecc Microbiol Clin 2019; 37:661-667. [PMID: 30630634 DOI: 10.1016/j.eimc.2018.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/07/2018] [Indexed: 12/28/2022]
Abstract
Cervicitis is the inflammation of the cervix. It is usually caused by an infectious agent, usually sexually transmitted. Cervicitis is frequently asymptomatic and silent infection can cause complications of the upper genital tract. The symptoms are usually nonspecific, the most significant being an increase in vaginal discharge and/or intermenstrual bleeding. For its diagnosis, there are commercial systems based on molecular techniques that include almost all of the known pathogens associated with cervicitis, although cultures should not be abandoned due to the need to conduct studies of susceptibility to antibiotics. It is recommended to initiate an empirical antibiotic therapy that covers C.trachomatis and N.gonorrhoeae in the case of women at high risk of infection by these pathogens, especially if the follow-up is not assured or adequate diagnostic tests are not available. In women with low risk of sexually transmitted infection, antibiotic therapy should be adjusted to the results of the microbiological results.
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Affiliation(s)
- Victoria Ortiz-de la Tabla
- Servicio de Microbiología, Hospital Universitario San Juan de Alicante, Sant Joan d'Alacant, Alicante, España.
| | - Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital General Universitario de Elche, Universidad Miguel Hernández, Elche, Alicante, España
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17
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Randjelovic I, Moghaddam A, Freiesleben de Blasio B, Moi H. The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection. Infect Dis Obstet Gynecol 2018; 2018:8236575. [PMID: 30147292 PMCID: PMC6083538 DOI: 10.1155/2018/8236575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 07/04/2018] [Indexed: 11/26/2022] Open
Abstract
Objective The aim of this study was to evaluate whether the polymorphonuclear leukocyte (PMNL) inflammatory response in women with nongonococcal lower genital tract infection (LGTI) can be used to optimize criteria for syndromic treatment. Methods A cross-sectional study of 375 women attending the STI clinic in Oslo. Urethral, cervical, and vaginal specimens underwent microscopy for PMNLs. Chlamydia trachomatis (Ct) and other STIs were detected in the cervical/vaginal swabs and urine, using nucleic acid amplification test (NAAT). After excluding vulvovaginal candidiasis, genital herpes, and trichomoniasis, we correlated clinical and microscopic signs of inflammation with positive NAAT for Ct, mycoplasma genitalium (Mg), and Ureaplasma urealyticum (Uu) in a subgroup of 293 women. Results To predict a positive Ct, the combination of high cut-off urethritis (≥10 PMNLs/HPF) and microscopic cervicitis had a high specificity of 0.93, a PPV of 0.37, and a sensitivity of 0.35. LGTI criteria had low predicting values for Mg and Uu. Conclusion Including microscopic criteria for the diagnosis of LGTI gives better indication for presumptive antibiotic treatment than anamnestic and clinical diagnosis alone.
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Affiliation(s)
- Ivana Randjelovic
- Oslo University Hospital, Department of Venereology, The Olafia Clinic, Norwegian National Advisory Unit on Sexually Transmitted Infections, Oslo, Norway
| | | | - Birgitte Freiesleben de Blasio
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
- Department of Biostatistics, Oslo Centre for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Harald Moi
- Oslo University Hospital, Department of Venereology, The Olafia Clinic, Norwegian National Advisory Unit on Sexually Transmitted Infections, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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18
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Horner P, Donders G, Cusini M, Gomberg M, Jensen JS, Unemo M. Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? - a position statement from the European STI Guidelines Editorial Board. J Eur Acad Dermatol Venereol 2018; 32:1845-1851. [PMID: 29924422 DOI: 10.1111/jdv.15146] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
At present, we have no evidence that we are doing more good than harm detecting and subsequently treating Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum colonizations/infections. Consequently, routine testing and treatment of asymptomatic or symptomatic men and women for M. hominis, U. urealyticum and U. parvum are not recommended. Asymptomatic carriage of these bacteria is common, and the majority of individuals do not develop any disease. Although U. urealyticum has been associated with urethritis in men, it is probably not causal unless a high load is present (likely carriage in 40-80% of detected cases). The extensive testing, detection and subsequent antimicrobial treatment of these bacteria performed in some settings may result in the selection of antimicrobial resistance, in these bacteria, 'true' STI agents, as well as in the general microbiota, and substantial economic cost for society and individuals, particularly women. The commercialization of many particularly multiplex PCR assays detecting traditional non-viral STIs together with M. hominis, U. parvum and/or U. urealyticum has worsened this situation. Thus, routine screening of asymptomatic men and women or routine testing of symptomatic individuals for M. hominis, U. urealyticum and U. parvum is not recommended. If testing of men with symptomatic urethritis is undertaken, traditional STI urethritis agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, M. genitalium and, in settings where relevant, Trichomonas vaginalis should be excluded prior to U. urealyticum testing and quantitative species-specific molecular diagnostic tests should be used. Only men with high U. urealyticum load should be considered for treatment; however, appropriate evidence for effective treatment regimens is lacking. In symptomatic women, bacterial vaginosis (BV) should always be tested for and treated if detected.
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Affiliation(s)
- P Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
| | - G Donders
- Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium
| | - M Cusini
- Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy
| | - M Gomberg
- Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia
| | - J S Jensen
- Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark
| | - M Unemo
- Department of Laboratory Medicine, Microbiology, World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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19
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Kletzel HH, Rotem R, Barg M, Michaeli J, Reichman O. Ureaplasma urealyticum: the Role as a Pathogen in Women's Health, a Systematic Review. Curr Infect Dis Rep 2018; 20:33. [PMID: 29959546 DOI: 10.1007/s11908-018-0640-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW To evaluate the role of Ureaplasma urealyticum as a genital pathogen in women's health. Three aspects were analyzed: (1) preterm delivery (PTD); (2) female infertility; and (3) lower genital tract pathology including pelvic inflammatory disease (PID), cervicitis, and genital discomfort (discharge, burning). RECENT FINDINGS A systematic review was performed. Searching PUBMED and EMBASE for published articles from January 2003 to September 2017 using the key word "Ureaplasma urealyticum" yielded 1835 manuscripts. These were further screened using defined inclusion criteria: (1) original peer-reviewed observational studies; (2) English language; (3) U. urealyticum was specifically isolated; (4) present "cases"/"exposed" and "controls"/"unexposed" to enable calculating an association between U. urealyticum and the outcome studied. Altogether, 32 studies were included that underwent quality scoring based on methodology, sample size, study population, and method of identification of U. urealyticum. The association of U. urealyticum and PTD was inconsistent between the studies. Eight of the ten prospective studies failed to show an association between U. urealyticum and PTD, yet four of the six case control studies found a positive association. Regarding female infertility and genital discomfort, five of the six studies for each of these topics failed to find an association. Only two studies met the inclusion criteria for cervicitis with conflicting conclusions. Unfortunately, none of the studies met the inclusion criteria for PID. It seems that U. urealyticum has a limited role as a pathogen in female infertility, cervicitis, PID, and genital discomfort. The role as a pathogen in PTD is unclear and future studies are needed to address this issue.
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Affiliation(s)
- Hanna Hershko Kletzel
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Reut Rotem
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Moshe Barg
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Jennia Michaeli
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
| | - Orna Reichman
- Department of Obstetrics and Gynecology, Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel.
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20
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Kim SI, Yoon JH, Park DC, Lee DS, Lee SJ, Choe HS, Kim JH, Park TC, Lee SJ. Co-infection Of Ureaplasma urealyticum And Human Papilloma Virus In Asymptomatic Sexually Active Individuals. Int J Med Sci 2018; 15:915-920. [PMID: 30008604 PMCID: PMC6036102 DOI: 10.7150/ijms.26523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/27/2018] [Indexed: 12/11/2022] Open
Abstract
This study aimed to determine the role of asymptomatic bacterial sexually transmitted infections (STIs), such as Chlamydia trachomatis (Ct), Mycoplasma genitalium (Mg), Mycoplasma hominis (Mh), and Ureaplasma urealyticum (Uu) in human papillomavirus (HPV) infection. In total, 264 asymptomatic outpatients aged between 21 and 80 years were prospectively enrolled in this study during routine gynecological screening tests. Specimens collected with a Cervex Brush were routinely analyzed with the Hybrid Capture 2 assay for HPV. Simultaneously, a specimen obtained with an endocervical swab was used to detect Ct and Mg with a monoplex real-time polymerase chain reaction (PCR) and to confirm Mh and Uu with a Mycoplasma IST 2 kit. The detection rates (%) of HPV, Ct, Mg, Mh, and Uu were 82/264 (31.1), 6/264 (2.3), 5/264 (1.9), 16/264 (6.1), and 95/264 (36.0), respectively. Of 95 Uu, 32 (33.7%) showed high density colonization (HDC, ≥104 color-changing units/mL). HDC-Uu was significantly associated with HPV infection (p=0.014, chi-square test). Mg infection and Mh infection were not associated with HPV infection (p=0.981 and p=0.931, chi-square test). Age was not associated with HPV infection or bacterial infection. Our data suggested that asymptomatic HDC-Uu was closely associated with HPV infection. Therefore, simultaneous evaluation for Uu and HPV should be performed during gynecological screening, even in asymptomatic individuals.
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Affiliation(s)
- Sang Il Kim
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Joo Hee Yoon
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Dong Choon Park
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Dong Sup Lee
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Seung Ju Lee
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Hyun Sop Choe
- Department of Urology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jin Hwi Kim
- Department of Obstetrics and Gynecology, College of Medicine, Uijeongbu St. Mary Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Tae Chul Park
- Department of Obstetrics and Gynecology, College of Medicine, Uijeongbu St. Mary Hospital, The Catholic University of Korea, Uijeongbu, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, Suwon, Republic of Korea
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Amorim AT, Marques LM, Campos GB, Lobão TN, de Souza Lino V, Cintra RC, Andreoli MA, Villa LL, Boccardo E, Junior ACRB, López RVM, Dos Santos DB, de Souza GM, Romano CC, Timenetsky J. Co-infection of sexually transmitted pathogens and Human Papillomavirus in cervical samples of women of Brazil. BMC Infect Dis 2017; 17:769. [PMID: 29246195 PMCID: PMC5732421 DOI: 10.1186/s12879-017-2835-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 11/15/2017] [Indexed: 11/17/2022] Open
Abstract
Background Some sexually transmitted infectious agents, such as Chlamydia trachomatis and Herpes simplex, cause local inflammation, and could contribute to Human Papillomavirus (HPV) and cervical lesion progression. Thus, the aim of this study was to determine any association between the presence of microorganisms of gynecological importance, sexual behavior, clinical and demographical variables to the development and progress of cervical lesions. Methods One hundred and thirty-two women between 14 and 78 years and living at Vitória da Conquista, Bahia, Brazil, were included (62 individuals with cervical lesions and 70 without lesions). They answered a questionnaire to provide data for a socioeconomic and sexual activity profile. Samples of cervical swabs were collected and analyzed by PCR to detect genital microorganisms and HPV. Quantitative PCR was used to detect and quantify Ureaplasma urealyticum and Ureaplasma parvum. Univariate and multiple logistic regression were performed to measure the association with the cervical lesions, and an odds ratio (OR) with 95% confidence intervals (95%CI) were calculated. The Mann-Whitney U test was also used to compare the microorganism load in the case and control groups. The significance level was 5% in all hypotheses tested. Results Cervical lesions were associated with: women in a stable sexual relationship (OR = 14.21, 95%CI = 3.67–55.018), positive PCR for HPV (OR = 16.81, 95%CI = 4.19–67.42), Trichomonas vaginalis (OR = 8.566, 95%CI = 2.04–35.94) and Gardnerella vaginalis (OR = 6.13, 95%CI = 1.53–24.61), adjusted by age and qPCR for U. parvum. U. parvum load showed a statistical difference between the case and control groups (p-value = 0.002). Conclusion Variables such as stable relationship, HPV, T. vaginalis, G. vaginalis were associated with cervical lesions in epidemiological studies. U. parvum load was higher in woman with cervical lesions compared with women without lesions. Additional studies are needed to better understand the role of these factors in cervical lesion development. Electronic supplementary material The online version of this article (10.1186/s12879-017-2835-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aline Teixeira Amorim
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil
| | - Lucas Miranda Marques
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil. .,Instituto Multidisciplinar em Saúde/Campus Anísio Teixeira, Universidade Federal da Bahia - IMS/CAT-UFBA, Vitória da Conquista, Brazil.
| | - Guilherme Barreto Campos
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil.,Instituto Multidisciplinar em Saúde/Campus Anísio Teixeira, Universidade Federal da Bahia - IMS/CAT-UFBA, Vitória da Conquista, Brazil
| | - Tássia Neves Lobão
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil
| | - Vanesca de Souza Lino
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil
| | | | - Maria Antonieta Andreoli
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, FCMSCSP, A.C. Camargo Cancer Center, São Paulo, Brazil
| | - Luisa Lina Villa
- Faculdade de Medicina da Universidade de São Paulo, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - Enrique Boccardo
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil
| | | | | | | | | | - Carla Cristina Romano
- Universidade Estadual de Santa Cruz (UESC), Campus Soane Nazaré de Andrade, Ilhéus, Brazil
| | - Jorge Timenetsky
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, ICB/USP, Avenue Prof. Lineu Prestes n°1374 - Butantã, São Paulo, SP, 05508-900, Brazil
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Sweeney EL, Dando SJ, Kallapur SG, Knox CL. The Human Ureaplasma Species as Causative Agents of Chorioamnionitis. Clin Microbiol Rev 2017; 30:349-379. [PMID: 27974410 PMCID: PMC5217797 DOI: 10.1128/cmr.00091-16] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The human Ureaplasma species are the most frequently isolated microorganisms from the amniotic fluid and placentae of women who deliver preterm and are also associated with spontaneous abortions or miscarriages, neonatal respiratory diseases, and chorioamnionitis. Despite the fact that these microorganisms have been habitually found within placentae of pregnancies with chorioamnionitis, the role of Ureaplasma species as a causative agent has not been satisfactorily explained. There is also controversy surrounding their role in disease, particularly as not all women infected with Ureaplasma spp. develop chorioamnionitis. In this review, we provide evidence that Ureaplasma spp. are associated with diseases of pregnancy and discuss recent findings which demonstrate that Ureaplasma spp. are associated with chorioamnionitis, regardless of gestational age at the time of delivery. Here, we also discuss the proposed major virulence factors of Ureaplasma spp., with a focus on the multiple-banded antigen (MBA), which may facilitate modulation/alteration of the host immune response and potentially explain why only subpopulations of infected women experience adverse pregnancy outcomes. The information presented within this review confirms that Ureaplasma spp. are not simply "innocent bystanders" in disease and highlights that these microorganisms are an often underestimated pathogen of pregnancy.
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Affiliation(s)
- Emma L Sweeney
- Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Samantha J Dando
- Monash Biomedicine Discovery Institute, Department of Anatomy and Developmental Biology, Monash University, Clayton, Victoria, Australia
| | - Suhas G Kallapur
- Division of Neonatology, the Perinatal Institute, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Christine L Knox
- Institute of Health and Biomedical Innovation, Faculty of Health, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
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