High prevalence of Mycoplasma genitalium in women presenting for termination of pregnancy

BACKGROUND: Sexually transmitted infections increase the risk of postoperative complications after termination of pregnancy. Mycoplasma genitalium is sexually transmitted and associated with adverse clinical outcomes in both males and females. The prevalence of M. genitalium is not yet known in New Zealand women or among women presenting for termination of pregnancy. STUDY DESIGN: This study involved prospective data collection at a public hospital clinic for termination of pregnancy. Participants were 300 under 25-year-old women presenting for termination of pregnancy. The study aimed to describe the prevalence of M. genitalium in women presenting for termination of pregnancy using real-time polymerase chain reaction (PCR) testing. Women provided a vaginal swab that was sent to the laboratory for PCR detection of M. genitalium. Data collection included age, ethnicity, previous pregnancy history, gestational age, procedure type, results of STI tests performed on referral for a termination of pregnancy (C. trachomatis, N. gonorrhoeae, T. vaginalis and bacterial vaginosis) and use of antimicrobials in the past 3 weeks. RESULTS: M. genitalium was detected in 26 women (8.7%). Rates of infection did not differ significantly by patient characteristics such as age, ethnicity or previous pregnancies. Infection with M. genitalium was not significantly associated with bacterial vaginosis or C. trachomatis infection. CONCLUSIONS: To our knowledge, this is the first prospective study designed to determine the prevalence of M. genitalium in women presenting for termination of pregnancy. Given the high proportion of cases observed in this study, further research is needed to determine the clinical significance of M. genitalium in postoperative termination of pregnancy complications.     

淋病患者支原体、衣原体感染分析

目的为了解淋病患者解脲脲支原体(Uu)、人支原体(Mh)、肺炎支原体(Mpn)、生殖道支原体(Mg)、穿透支原体(Mpe) 、发酵支原体(Mf)、梨形支原体(Mpi)和沙眼衣原体(Ct)合并感染情况. 方法采用套式聚合酶链反应(nPCR)和聚合酶链反应(PCR)技术,对100例女性淋病患者宫颈分泌物和91例男性淋病患者尿道分泌物做了上述7种支原体和沙眼衣原体的检测. 结果在女性淋病患者中,Uu、Mh、Mpn、Mpe、Mg、Mf、Mpi和Ct的检测率分别为46%、34%、18%、13%、11%、4%、0、13%,在男性淋病患者中,Uu、Mh、Mg、Mpe、Mpn、Mf、Mpi和Ct的检测率分别为48.4%、14.3%、13.2%、13.2%、8.8%、1.1%、0、5.5%. 结论在淋病患者中支原体和沙眼衣原体合并感染严重.     

男女性生殖道炎性疾病者阴道加德纳菌及其他病原菌感染研究

目的了解男女性生殖道炎性疾病者阴道加德纳菌及其他病原菌的感染状况.方法收集2003年10月～2004年8月,无锡地区682例(男459例,女223例)男女性生殖道炎性疾病患者的尿道和宫颈分泌物标本及115例前列腺炎患者的前列腺液标本,进行阴道加德纳菌(GV)、解脲脲支原体(Uu)、人支原体(MH)、生殖道支原体(MG)、肺炎支原体(MP)、淋病奈瑟球菌(NG)、沙眼衣原体(CT)检测,女性同时进行念珠菌和滴虫检测.结果男性生殖道患者GV阳性率为8.1%,居NG(37.3%)、Uu(22.7%)之后列第3位;女性Gv为28.3%,居念珠菌(42.6%)、Uu(38.6%)之后也列第3位.结论男女性生殖道炎性疾病患者GV阳性率较高,在检出的病原菌中居第3位,对STD患者应注重GV的检测及治疗.     

Etiology of urethral discharge in West Africa: the role of Mycoplasma genitalium and Trichomonas vaginalis

OBJECTIVE: To determine the etiological role of pathogens other than Neisseria gonorrhoeae and Chlamydia trachomatis in urethral discharge in West African men. METHODS: Urethral swabs were obtained from 659 male patients presenting with urethral discharge in 72 primary health care facilities in seven West African countries, and in 339 controls presenting for complaints unrelated to the genitourinary tract. Polymerase chain reaction analysis was used to detect the presence of N. gonorrhoeae, C. trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, and Ureaplasma urealyticum. FINDINGS: N. gonorrhoeae, T. vaginalis, C. trachomatis, and M. genitalium--but not U. urealyticum--were found more frequently in men with urethral discharge than in asymptomatic controls, being present in 61.9%, 13.8%, 13.4% and 10.0%, respectively, of cases of urethral discharge. Multiple infections were common. Among patients with gonococcal infection, T. vaginalis was as frequent a coinfection as C. trachomatis. M. genitalium, T. vaginalis, and C. trachomatis caused a similar clinical syndrome to that associated with gonococcal infection, but with a less severe urethral discharge. CONCLUSIONS: M. genitalium and T. vaginalis are important etiological agents of urethral discharge in West Africa. The frequent occurrence of multiple infections with any combination of four pathogens strongly supports the syndromic approach. The optimal use of metronidazole in flowcharts for the syndromic management of urethral discharge needs to be explored in therapeutic trials.     

不孕不育患者支原体感染情况和耐药率分析

目的探讨本地区不孕不育患者解脲支原体(Ureaplasma urealyticum,UU)和人型支原体(Mycoplasma hominis,MH)感染率和耐药率,以期了解支原体在该人群流行情况和耐药率变化情况,为治疗选择合适的抗菌药物。方法对2012年1月-2013年11月期间济宁市第一人民医院生殖科门诊4 266例不孕不育患者培养法检测UU和MH,并对1 557例阳性标本行体外药敏实验,分析其耐药现状。结果不孕不育患者支原体总感染率为36.5%,UU感染率显著高于MH感染率(P0.01)。男性和女性生殖道支原体感染率分别为31.8%、45.4%,女性支原体感染率显著高于男性(P0.01)。生殖道支原体对喹诺酮类抗菌药物耐药率相对较高,对大环内酯类和四环素类耐药率较低。2013年支原体对12种抗菌药物的耐药率同比多数降低。MH对多数抗菌药物耐药率均较高,对美满霉素、强力霉素药物高度敏感。结论不孕不育患者具有较高的UU和MH感染率,支原体对常用抗菌药物有一定耐药性,临床应根据药敏结果有选择性地使用抗菌药物。     

Mycoplasmas in the urine of HIV-1 infected men

The aim of this study was determine the prevalence of Mycoplasma hominis, M. genitalium, M. fermentans, M. pirum, M. penetrans and Ureaplasma urealyticum in HIV-infected patients. Culture and PCR were used to detect six species of Mycoplasma in first-void urine of HIV-1 infected men. A total of 497 HIV/AIDS patients (age range 5-75 years, mean 37 years) were screened in the study. All presented positive for at least one kind of mycoplasma, especially U. urealyticum and M. hominis. Six mycoplasmas were significant in the homosexual contact and heterosexual contact groups. The distribution of M. hominis, M. penetrans, and M. pirum were significantly different in this four-transmission category. CD4+ cell count levels were lower in the AIDS-associated Mycoplasma-positive group than in the Mycoplasma-negative group (P<0.01). This study indicates that U. urealyticum, M. hominis and M. fermentans are prevalent in HIV-1-infected male patients. This may be an indication of whether mycoplasmas are co-factors in the progression of HIV disease.     

宫颈分泌物支原体检测及耐药性分析

目的探讨女性生殖道支原体感染及药敏情况。方法应用培养法对女性生殖道炎症患者宫颈分泌物进行支原体检测，同时测定其对抗菌药物的耐药性。结果588例炎症患者中318例支原体阳性，感染率为54．1％；其中解脲脲支原体（Uu）感染312例（98．1％），人支原体（Mh）感染6例（1．9％），12种抗菌药物药敏结果显示：支原体对8种抗菌药物敏感率〉80％，敏感率最低的是螺旋霉素、四环素、红霉素。结论研究表明女性生殖道炎症患者中Uu感染率明显上升，且耐药株在不断增加。     

1636例宫颈拭子支原体、衣原体检测及支原体耐药性分析

目的 探讨宫颈沙眼衣原体（CT）、解脲支原体（UU）和人型支原体（MH）的感染情况及了解支原体耐药情况。方法 应用金标法及支原体培养＋药敏分析，对1636例宫颈拭子进行CF、UU和MH三种病原体检测。结果 （1）三种病原体总检出率为49．08％（803／1636）。其中单种病原体检出率为39．06％（639／1636），混合感染率为10.02％（164／1636）；衣原体检出率为11.61％（190／1636）；支原体检出率为37．47％（613／1636）。（2）衣、支原体感染以21～40岁为主，占阳性患者的79．58％。（3）对支原体耐药率最高的是壮观霉素（耐药率〉90％），其中人型支原体及解脲＋人型混合感染者对壮观霉素、罗红霉素、红霉素、阿齐霉素、克拉霉素等耐药率均〉80％；对交沙霉素最敏感，其次是强力霉素。结论 （1）UU、CF、MH是宫颈感染的主要病原体，其感染率依次为UU〉CT〉MH。（2）支原体的耐药菌株较常见，临床治疗应根据药敏结果选择敏感药物。     

2556例门诊患者支原体、衣原体检测及支原体感染药敏分析

目的调查门诊患者的溶脲脲原体（Uu）、人型支原体（Mh）和沙眼衣原体（Ct）的感染率,分析支原体对10种常用药物的敏感情况。方法采用珠海银科和英国立明试剂进行检测,分析病原体的感染及支原体药敏。结果2006年1月-2009年10月间岳阳市第二人民医院2556例门诊标本中总阳性率为55.8%,男性和女性感染阳性率为分别40.7%、75.3%;总感染阳性率Uu为41.7%,Mh为23.1%,Ct为14.8%;单纯感染阳性率Uu为22.3%,Mh为5.6%,Ct为4.9%。年龄分段以20～30岁标本数762例、感染率64.3%为首。年度感染阳性率基本一致。以强力霉素、交沙霉素、美满霉素为药物敏感率前三位,分别为81.3%、73.4%、71.1%;氧氟沙星、环丙沙星、阿齐霉素的耐药率为前三位,分别为57.6%、55.7%、51.7%。结论本地区支原体、衣原体感染率较高,女性感染率明显高于男性。治疗用药首选强力霉素、交沙霉素、美满霉素。加强对NGU易感人群的性健康知识和婚姻道德观念教育。     

Infection with Chlamydia trachomatis in female college students

Chlamydia trachomatis was isolated from genital specimens from 21 (4.9%) of 431 female college students. Antibody to C. trachomatis was found in the genital secretions of 52 (11.9%) of 437 women. Multiple logistic regression analysis showed race, number of sexual partners, and use of barrier methods of contraception to be predictive of infection with C. trachomatis. Logistic regression analysis found race, number of sexual partners, use of barrier methods of contraception, and presence of cervical erythema to be predictive of local chlamydial antibody. White participants were infected less often (12 of 388 (3.1%)) than black participants (9 of 43 (20.9%)) (p less than 0.001) and were less likely to have local chlamydial antibody. None of the sexually inexperienced women were infected or had local antibody. Among the sexually experienced women, chlamydial infection and local chlamydial antibody increased with increasing number of sexual partners only for women who were not using barrier methods of contraception. Sexually experienced women who used barrier methods of contraception (condom, diaphragm) were less likely to be infected (one of 105 (1.0%)) than were sexually experienced women who used other contraceptive measures or who did not use contraception (20 of 276 (7.2%)) (p = 0.031). Women who used barrier methods of contraception also were less likely to have local chlamydial antibody. Women with cervical erythema were more likely to have local chlamydial antibody (4 of 11 (36.4%)) than women without cervical erythema (48 of 426 (11.3%)). Vaginal colonization with other sexually transmitted microorganisms (Mycoplasma hominis, Ureaplasma urealyticum, Trichomonas vaginalis) was noted more often among women with chlamydial infection than among uninfected women.     

Laboratory diagnosis of Mycoplasma pneumoniae infection. 4. Antigen capture and PCR-gene amplification for detection of the Mycoplasma: problems of clinical correlation.

Direct detection assays for Mycoplasma pneumoniae were established by PCR amplification of short sequences within the foot protein/adhesin (P1) gene and the 16S ribosomal RNA gene. Specificity and sensitivity was excellent, no hybridization was observed with M. genitalium and other human Mycoplasma species. In nose and throat washings from subjects with respiratory infection a pattern of high counts (c.f.u./ml) of M. pneumoniae (deduced from the amount of amplified PCR product), and a positive antigen capture assay, was found in 83% of subjects with serological evidence of current infection with M. pneumoniae. A small proportion of subjects with serological patterns suggesting infection in the more distant past had positive PCR assays. This was considered to represent either persistence of the organism from a previous infection or perhaps transient carriage during a reinfection, without substantial change in antibody response. PCR-based assay of M. pneumoniae offers a powerful, rapid, and sensitive substitute for culture of the mycoplasma. Antigen capture, while less sensitive than PCR, offers the advantage that it is more often positive with samples from current infection and requires less stringent laboratory organization to contain false positive results. We conclude however that the laboratory diagnosis of a chosen clinical episode should not rest on the PCR or Ag-EIA assays alone, but must also include antibody assays to confirm whether infection is current or represents persistence from past exposure.     

妇女生殖道人型支原体感染的流行病学调查

1990年6月我们对南京市下关区参加普查的722名妇女进行了阴道分泌物人型支原体抗原的检测。结果发现,人型支原体感染不存在年龄及职业的分布差异。怀孕次数超过3次的妇女人型支原体的感染显著较高,提示多次流产可能增加感染机会。避孕方式可以影响人型支原体的感染,用工具避孕的感染率最低,而用宫内节育环的妇女人型支原体的感染率最高。     

扬州市性传播疾病患者支原体、衣原体、淋病奈瑟菌及阴道加特纳菌感染情况的研究

目的 研究扬州市男性性传播疾病(STD)患者支原体、衣原体、淋病奈瑟菌及阴道加特纳菌的感染情况。方法 收集男性STD患者病灶拭子标本进行解脲脲原体(Uu)、人型支原体(Mh)、肺炎支原体(Mpn)、生殖支原体(Mg)、发酵支原体(Mf)、穿通支原体(Mpe)、梨支原体(Mpi)、沙眼衣原体(Ct)、肺炎衣原体(Cpn)、鹦鹉热衣原体(Cps)、淋病奈瑟菌(Ng)和阴道加特纳菌(GV)等12种病原体作巢式聚合酶链反应(nPCR)检测,并对Ng阳性者进行了产青霉素酶淋病奈瑟菌(PPNG)检测。结果 Un、Mh、Mpn和Mg 4种支原体阳性率分别为64.5％、27.6％、26.3％、18.4％,Mf和Mpe为2.6％,Mpi未检出;Ct为31.6％,Cpn和Cps无阳性病例检出;Ng为36.8％,其中PPNG占14.3％;GV阳性率为15.8％。淋球菌阳性的男性STD者与淋球菌阴性者中支原体核酸检出率差异有显著性(X~2=3.848,P<0.05)。结论 扬州市男性STD患者支原体、衣原体、淋病奈瑟菌、阴道加特纳菌感染率较高。在临床诊疗中应重视淋球菌、衣原体、支原体和阴道加特纳菌的检测,使患者能获得正确诊断与合理治疗。     

Recovery of Chlamydia and Genital Mycoplasma transported in sucrose phosphate buffer and urease color test medium.

Urethral swabs from 75 males with urethritis were extracted into tryptose phosphate broth and then equal aliquots were dispensed into vials containing sucrose phosphate buffer (2SP) and urease color test medium (U-9). No antibiotics were present in the media. After transport to the laboratory, the recovery of Chlamydia trachomatis and Ureaplasma urealyticum was evaluated after inoculation into McCoy's cell cultures and agar medium, respectively. C. trachomatis was recovered from significantly more patients (17 versus 12, P = 0.03) with higher inclusion counts (P less than 0.01) in specimens transported in 2SP as compared with those in U-9 medium. No significant differences between the isolation rate of U. urealyticum and that of Mycoplasma hominis were found with the two media. The rate of inactivation of C. trachomatis and U. realyticum at 4 C was examined by means of reference strains. The inactivation of C. trachomatis was similar in both 2SP and U-9 media, but the number of inclusions was consistently greater in the 2SP medium. In contrast, the number of colony-forming units of U. urealyticum actually increased over a 24-hour period in both media. We conclude that 2SP is the best medium for the combined recovery of C. trachomatis and genital Mycoplasma. The use of one transport medium and hence a single swab culture has the obvious advantages of saving time and expense for both physician and laboratory, and for the patient it will eliminate the possible discomfort of having multiple cultures taken.     

淋病患者中支原体和衣原体感染频率的初步血清学调查

对123例淋病患者和108名健康人的血清应用PHA进行Mh和Ct抗体检测。结果表明,淋病患者的Mh抗体阳性率为23.58%,GMT为1:7.60;Ct抗体阳性率为72.35%,GMT为1:8.71。显著高于健康人的Mh和Ct抗体水平(P<0.05)。提示柳州地区淋病病人生殖道Ct和Mh感染较为普遍,在性病防治工作中应予重视。此外,还对探讨生殖道Mh和Ct感染的意义、分布特点和淋病患者Mh和Ct感染的高发原因进行了讨论。     

Prevalence survey on condom use and infection of urogenital mycoplasmas in female sex workers in China

GOAL: We evaluated the prevalence of condom use and the effects of condom use on urogenital mycoplasma infection in female sex workers in Jinjiang, China. METHODS: Two-hundred ninety-nine female sex workers from Jinjiang city, Jiangsu Province, were interviewed, and three mycoplasmas of Ureaplasma urealyticum (Uu), Mycoplasma hominis (Mh) and Mycoplasma genitalium (Mg) were detected by nested polymerase chain reaction in genital secretions of 72 female sex workers and 42 female patients seen with symptoms of genital infection (control group). RESULTS: The results showed that 87.29% of the sex workers used condom in their last sexual intercourse, and that 2.68% did not use, 38.80% sometimes used and 58.52% used condoms every time in the last month. Those who were older, married and have a stable partnership used condoms less frequently. The infection rates of Uu, Mh and Mg were 77.78%, 34.72% and 16.67%, respectively, in sex worker subjects compared to those of controls at 59.52%, 9.62% and 21.43%, respectively. The infection rates of Uu and Mg were lower among all subjects (NS) who used condoms every time. In this observational study, genital mycoplasma infection was common and occurred more frequently among sex workers, and infection occurred less often when condoms were used. These results tend to support the efficacy of condom use in reducing urogenital mycoplasma infection among Chinese women.     

Sociocultural factors in puerperal infectious morbidity among Navajo women

From 1980 to 1982, a sample of 968 pregnant Navajo women in New Mexico was enrolled in a prospective study of biologic and sociocultural factors in puerperal infectious morbidity. Past studies have independently implicated both genital infection and psychosocial stressors in perinatal complications, but, to the authors' knowledge, no previous work has concurrently investigated the interactive effects of genital pathogens and psychosocial processes. Endocervical cultures for Mycoplasma hominis and Chlamydia trachomatis were obtained during prenatal visits, and structured interviews were conducted assessing social support and the degree of cultural traditionality, in this context a proxy measure of acculturative stress. The incidences of postpartum fever, endometritis, and premature rupture of membranes were significantly associated with the concurrence of two factors: the presence of genital tract M. hominis and a highly traditional cultural orientation. When demographic and conventional obstetric risk factors were controlled for, women with both M. hominis and high traditionality experienced infectious complications at a rate twice that of women with either factor alone. Among the plausible explanations for this result is the possibility that acculturative stress undermines physiologic resistance to infectious genital tract disease.     

Genital infection by Chlamydia trachomatis in Lisbon: prevalence and risk markers

BACKGROUND: There is little information about the prevalence and risk markers for Chlamydia trachomatis infections in Portugal. OBJECTIVES: Our aim was to assess the prevalence of C. trachomatis genital infection and to study variables associated with this infection in a group of sexually active women aged < or =30 years living in the Lisbon area and to estimate the prevalence of C. trachomatis infection among partners of infected patients. METHODS: A systematic sample of women observed in general practice family planning and teenager clinics was collected. A questionnaire was administered, followed by a pelvic examination. A first-catch urine sample was taken for polymerase chain reaction (PCR) Amplicor assay. When a sample tested positive, the woman was invited to obtain a urine sample from her partner. Socio-demograhic, behavioural and clinical variables were studied and their association with the PCR Amplicor result was assessed. RESULTS: A total of 1108 women, aged between 14 and 30 years, were studied. Fifty-one women (4.6% of total sample) tested positive for C. trachomatis. The prevalence of infection was slightly higher in patients aged < or =19 years (5.3%) than in age groups 20-25 (4.8%) and 26-30 years (3.9%). African ethnicity was related to a higher percentage of infection than European ethnicity: 9.8% versus 3.8%, P= 0.0067. Use of condoms "sometimes/never" was associated with a higher prevalence of infection: 5.2% versus 2.3% in those responding "always/almost always" (P= 0.0447). An altered cervix was associated with a higher prevalence of infection: 7.3% versus 3.7% with a normal cervix (P= 0.0106). Urine samples were obtained from 16 partners of infected patients. Six partners (37.5%) tested positive for C. trachomatis. CONCLUSIONS: A 4.6% prevalence of C. trachomatis genital infection was found. African ethnicity, using condoms "sometimes/never" and an altered cervix were associated with C. trachomatis infection, but showed low positive predictive value for C. trachomatis infection. Younger age may be associated with a slight increase in risk. Contact tracing for diagnosis and treatment remains a difficult issue to approach effectively.     

A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium

Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.     

北京地区285例女童外阴阴道炎性传播疾病相关病原体监测

目的探讨人生殖道易感支原体和沙跟衣原体、淋球菌等病原体与女童外阴阴道炎的关系，了解与性传播疾病（STD）相关病原体在女童外阴阴道炎感染病原中所占的比例。方法采集285例外阴阴道炎及128例健康对照组女童外阴拭子标本，采用nPCR技术对所有标本进行淋球菌（Ng）、沙眼衣原体（Ct）、解脲脲原体（Uu）、人型支原体（Mh）、生殖支原体（Mg）、发酵支原体（Mf）、穿透支原体（Mpe）检测。结果病例组的285例标本中，STD相关病原体阳性检出率为59，65％。单一病原体感染阳性检出率为37.54％；两种病原体混合感染阳性检出率为16．84％；三种病原体混合感染阳性检出率为5．26％。对照组128例标本中，7例为阳性检出标本，总检出率为6．25％，其中Uu5例、Mh2例。与对照组相比，Ng（P〈0．01）、Ct（P〈0.01）、Uu（P〈0．01）、Mg（P〈0．01）、Mf（P〈0．05）、Mpe（P〈0．01）在外生殖道的定植与女童外阴阴道炎的发生有相关性。结论一些与性传播疾病相关病原体是引起女童外阴阴道炎的主要病原体，并存在多病原体协同感染的情况。Mg、Mf、Ng在外生殖道的定植与季节有相关性。大环内酯类抗生素对儿童泌尿生殖道支原体、Ct感染的治疗有很好的临床疗效。