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Drew RJ, Eogan M. Treatment of Mycoplasma genitalium infection in pregnancy: A systematic review of international guidelines. Int J Gynaecol Obstet 2024. [PMID: 38491782 DOI: 10.1002/ijgo.15469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Mycoplasma genitalium is an emerging pathogen, which has been linked to cervicitis, urethritis and pelvic inflammatory disease (PID). With the advent of multiplex polymerase chain reaction (PCR) panels for sexually transmitted infections, it is increasingly being identified in pregnant women. OBJECTIVES The aim was to review international guidelines, which had explicit recommendations for treatment of M. genitalium infection in pregnancy and breastfeeding. SEARCH STRATEGY PubMed, EMBASE and Cochrane databases were reviewed with no age, species, language or date restrictions. SELECTION CRITERIA Studies were included if they had an explicit recommendation for treatment of M. genitalium in pregnancy. Studies were excluded if there was no recommendation in pregnancy, if they referred to other international guideline recommendations or were historical versions of guidelines. DATA COLLECTION AND ANALYSIS References were manually reviewed and 50 papers were selected for review. Only four guidelines were included in the final analysis and they were from Europe, UK, Australia and Aotearoa New Zealand. MAIN RESULTS All studies recommended azithromycin as first-line treatment, and advised against moxifloxacin use. The dosing schedule of azithromycin, varied between guidelines, as did the utility/safety of pristinamycin for macrolide resistant infections. Safety data was generally reassuring for azithromycin but inconsistent for pristinamycin. CONCLUSIONS Azithromycin is the first-line treatment for macrolide susceptible or unknown resistance infections, but there is a lack of consistency regarding dosing of azithromycin or the utility/safety of pristinamycin for macrolide resistant infections in pregnancy/lactation.
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Affiliation(s)
- Richard J Drew
- Clinical Innovation Unit, Rotunda Hospital, Dublin, Ireland
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple Street, Dublin, Ireland
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Maeve Eogan
- Department of Obstetrics and Gynecology, Rotunda Hospital, Dublin, Ireland
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Miranda AE, Gaspar PC, Schörner MA, Barazzetti FH, Dias GB, Bigolin A, Pascom ARP, Barreira D, Bazzo ML. Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Mycoplasma genitalium and risk factors among pregnant women in Brazil: Results from the national molecular diagnosis implementation project. Int J Gynaecol Obstet 2024. [PMID: 38425195 DOI: 10.1002/ijgo.15447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 01/20/2024] [Accepted: 02/09/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Sexually transmitted infections (STIs) are a public health problem. The aim of the present study was to assess the prevalence and risk factors associated with at least one STI (Chlamydia trachomatis [CT], Neisseria gonorrhoeae [NG], Trichomonas vaginalis [TV], and Mycoplasma genitalium [MG]) in Brazil. METHODS A cross-sectional study was conducted using secondary data from the pilot implementation of the National Service for molecular diagnosis of CT, NG, TV, and MG in pregnancy. We obtained Ministry of Health surveillance data from the implementation project. Data encompassing pregnant women aged 15-49 years from public antenatal clinics in Brazil in 2022 were included. RESULTS A total of 2728 data of pregnant women were analyzed. The prevalence of at least one infection was 21.0% (573), with the highest prevalence in the Southeast region (23.3%) and the lowest in the Center-West region (15.4%). The prevalence of CT was 9.9% (270), NG 0.6% (16), TV 6.7% (184), and MG 7.8% (212). Factors associated with any infection were from 15 to 24 years (AOR = 1.93; 95% CI: 1.58-2.35); reported family income up to US$400 (AOR = 1.79; 95% CI: 1.03-3.34); declared not living maritally with their partners (AOR = 1.90, 95% CI: 1.52-2.37) and had more than one sexual partner in their lifetime (AOR = 2.09, 95% CI: 1.55-2.86). CONCLUSION This study showed a high prevalence of at least one STI among pregnant women in Brazil, particularly among younger women. It also provides up-to-date national data on CT, NG, TV, and MG infections in this population. These findings underscore the importance of enhancing access to STI screening for young pregnant women within the Brazilian public health system.
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Affiliation(s)
- Angélica Espinosa Miranda
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Doenças Infecciosas da Universidade Federal do Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Pâmela Cristina Gaspar
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade de Brasília, Brasília, Distrito Federal, Brazil
| | - Marcos André Schörner
- Laboratório de Biologia Molecular, Microbiologia e Sorologia do Programa de Pós-Graduação em Farmácia da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Fernando Hartmann Barazzetti
- Laboratório de Biologia Molecular, Microbiologia e Sorologia do Programa de Pós-Graduação em Farmácia da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Guilherme Borges Dias
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Alisson Bigolin
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Ana Roberta Pati Pascom
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Dráurio Barreira
- Departamento de HIV/AIDS, Tuberculose, Hepatites Virais e Infecções Sexualmente Transmissíveis do Ministério da Saúde, Brasília, Distrito Federal, Brazil
| | - Maria Luiza Bazzo
- Laboratório de Biologia Molecular, Microbiologia e Sorologia do Programa de Pós-Graduação em Farmácia da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
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Rossotti R, Travi G, Bana NB, Orcese C, Puoti M. A case of chronic bacterial prostatitis due to Mycoplasma genitalium. Sex Transm Infect 2023; 99:571-573. [PMID: 37963760 DOI: 10.1136/sextrans-2023-055935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/19/2023] [Indexed: 11/16/2023] Open
Abstract
Mycoplasma genitalium (MG) is a common cause of non-gonococcal urethritis, but a role in acute or chronic prostatitis has not been described. We describe the case of a 42-year-old man with recurrent urinary tract infections since 2018 who developed chronic prostatitis despite several and prolonged antibiotic courses. Multiparametric prostatic magnetic resonance showed peripheral inflammatory alterations. A 4-glass Meares-Stamey test detected MG in the third voided bladder (VB3) sample. Moxifloxacin 400 mg daily for 28 days resulted in sustained clinical and microbiological cure.
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Affiliation(s)
- Roberto Rossotti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Giovanna Travi
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Nicholas Brian Bana
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Carloandrea Orcese
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
| | - Massimo Puoti
- Department of Infectious Diseases, ASST Grande Ospedale Metropolitano Niguarda, School of Medicine and Surgery, Milano, Italy
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Hu M, Souder JP, Subramaniam A, Van Der Pol B, Xiao L, Gupta K, Dionne-Odom J, Geisler WM. Prevalence of Mycoplasma genitalium infection and macrolide resistance in pregnant women receiving prenatal care. Int J Gynaecol Obstet 2023; 160:341-344. [PMID: 36074058 PMCID: PMC10439771 DOI: 10.1002/ijgo.14443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 08/01/2022] [Accepted: 08/30/2022] [Indexed: 12/15/2022]
Affiliation(s)
- Muhan Hu
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jaclyn Paige Souder
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Akila Subramaniam
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barbara Van Der Pol
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Li Xiao
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kanupriya Gupta
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Jodie Dionne-Odom
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - William M. Geisler
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women’s Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Desdorf R, Andersen NM, Chen M. Mycoplasma genitalium prevalence and macrolide resistance-associated mutations and coinfection with Chlamydia trachomatis in Southern Jutland, Denmark. APMIS 2021; 129:706-710. [PMID: 34580906 PMCID: PMC9297889 DOI: 10.1111/apm.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 09/16/2021] [Indexed: 11/26/2022]
Abstract
This study aims to investigate prevalence of Mycoplasma genitalium and macrolide resistance‐associated mutations and coinfection with other sexually transmitted bacteria in Southern Jutland, Denmark, where this information is very limited. Urinary samples from patients suspected of sexually transmitted bacterial infections collected at primary healthcare facilities in Southern Jutland are routinely tested for Chlamydia trachomatis and Neisseria gonorrhoeae. 601 of these samples were analysed with SpeeDx MG+23S reagents, which can detect M. genitalium and macrolide resistance‐mediating mutations in the 23S rRNA gene. Moreover, 147 C. trachomatis positive urinary samples from routine test were also analysed with the PCR assay to detect M. genitalium. 72 out of 601 samples were detected positive for C. trachomatis (12%), five samples (0.83%) positive for N. gonorrhoeae and 25 samples positive for M. genitalium (4.2%). 14 of the 25 M. genitalium samples were detected having 23S rRNA gene mutations associated with macrolide resistance (56%). 25 of 147 C. trachomatis positive samples were tested positive for M. genitalium (17%) and two of them were positive for M. genitalium and N. gonorrhoeae (1.4%). The high prevalence of M. genitalium and macrolide resistance‐associated mutation and the coinfection with C. trachomatis in the region suggesting that M. genitalium testing should be included in routine sexually transmitted infection screening.
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Affiliation(s)
- Rasmus Desdorf
- Focused Research Unit in Molecular Diagnostic and Clinical Research, IRS-Center Southern Jutland, University of Southern Denmark, Soenderborg, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Niles Moller Andersen
- Focused Research Unit in Molecular Diagnostic and Clinical Research, IRS-Center Southern Jutland, University of Southern Denmark, Soenderborg, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Ming Chen
- Focused Research Unit in Molecular Diagnostic and Clinical Research, IRS-Center Southern Jutland, University of Southern Denmark, Soenderborg, Denmark.,Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
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de Vries HJC. Current challenges in the clinical management of sexually transmitted infections. J Int AIDS Soc 2019; 22 Suppl 6:e25347. [PMID: 31468689 PMCID: PMC6715942 DOI: 10.1002/jia2.25347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/21/2019] [Indexed: 12/16/2022] Open
Affiliation(s)
- Henry JC de Vries
- STI Outpatient ClinicInfectious Diseases DepartmentPublic Health Service (GGD) AmsterdamAmsterdamThe Netherlands
- Department of DermatologyAmsterdam UMCAmsterdam Institute for Infection and Immunity (AI&II)University of AmsterdamAmsterdamThe Netherlands
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Gratrix J, Plitt S, Turnbull L, Smyczek P, Brandley J, Scarrott R, Naidu P, Parker P, Blore B, Bull A, Shokoples S, Bertholet L, Martin I, Chernesky M, Read R, Singh A. Prevalence and antibiotic resistance of Mycoplasma genitalium among STI clinic attendees in Western Canada: a cross-sectional analysis. BMJ Open 2017; 7:e016300. [PMID: 28698342 PMCID: PMC5541599 DOI: 10.1136/bmjopen-2017-016300] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine the prevalence and correlates of Mycoplasma genitalium (MG) infection among men and women, determine the prevalence of gene mutations conferring resistance and compare test performance of female specimen types. METHODS A cross-sectional study was conducted on specimens collected for gonorrhoea (NG, Neisseria gonorrhoeae) and chlamydia (CT, Chlamydia trachomatis) among male and female Alberta STI clinic attendees using the M. genitalium transcription-mediated amplification-research use only test. Positive specimens were sequenced for 23SrRNA, parC and gyrA genes. Gender-stratified analysis compared test results using χ2 or Fisher's exact test, Mann-Whitney U test and logistic regression. Female endocervical and urine specimens were compared. RESULTS A total of 2254 individuals were tested; 53.8% (n=1212) were male. Male prevalence of MG was 5.3%; CT was 5.9% and NG was 1.8%. Correlates of male infection were a non-gonococcal urethritis diagnosis and NG coinfection. MG prevalence for women was 7.2%; CT was 5.8% and NG was 1.8%. Correlates of female infection were younger age, Indigenous/Other ethnicity and CT/NG coinfection. Nearly two-thirds of eligible specimens had mutations associated with macrolide resistance and 12.2% of specimens had a parC mutation signifying possible moxifloxacin resistance. There was high concordance (98.1%) of results between urine and endocervical swabs. CONCLUSIONS The high prevalence of MG relative to CT and NG supports the incorporation of MG testing into routine sexually transmissible infection screening. The high rate of resistance to macrolides and moxifloxacin raises concerns about treatment options. The good concordance of results between urine and endocervical swabs supports the use of female urine specimens for testing.
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Affiliation(s)
- Jennifer Gratrix
- STI Centralized Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sabrina Plitt
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - LeeAnn Turnbull
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - Petra Smyczek
- STI Centralized Services, Alberta Health Services, Edmonton, Alberta, Canada
- Edmonton STI Clinic, Alberta Health Services, Edmonton, Alberta, Canada
| | - Judith Brandley
- Edmonton STI Clinic, Alberta Health Services, Edmonton, Alberta, Canada
| | - Ron Scarrott
- Calgary STI Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Prenilla Naidu
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Canada
| | - Penny Parker
- Edmonton STI Clinic, Alberta Health Services, Edmonton, Alberta, Canada
| | - Brenda Blore
- Calgary STI Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Amy Bull
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - Sandy Shokoples
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - Lindsay Bertholet
- STI Centralized Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Irene Martin
- National Microbiology Laboratory, Winnipeg, Canada
| | | | - Ron Read
- Calgary STI Clinic, Alberta Health Services, Calgary, Alberta, Canada
| | - Ameeta Singh
- Edmonton STI Clinic, Alberta Health Services, Edmonton, Alberta, Canada
- University of Alberta, Edmonton, Canada
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