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Objectives: To identify the contribution of Mycoplasma genitalium to the aetiology of cervicitis in subSaharan Africa and its relative importance in the overall burden of sexually transmitted infections among female sex workers (FSW). Methods: The study population consisted of FSW recruited in Ghana and Bénin during the initial visit of a randomised controlled trial. A questionnaire was administered, a pelvic examination carried out, and cervical samples obtained for detection of M genitalium, Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Clinical signs potentially indicating cervicitis were cervical discharge, pus on the cervical swab, bleeding after sampling, and inflammatory cervix. Results: Among 826 FSW, 26.3% were infected with M genitalium. N gonorrhoeae was strongly and independently associated with each of the four signs of cervicitis (adjusted odds ratios (AOR): 4.1 to 6.0). The AOR for C trachomatis were intermediate (1.3-4.1) and the AOR for M genitalium were lower (between 1.6 and 1.8) but statistically significant (p(0.05) for each sign. Conclusions: M genitalium is weakly associated with signs of cervicitis in west African FSW but is highly prevalent.

Understanding the origin and nature of hepatitis C virus (HCV) genetic diversity is critical for improving treatment and vaccine design, and such diversity is the sole source of information about the virus' epidemic history prior to its identification 20 years ago. In this paper, we study the molecular epidemiology of HCV genotype 2 in its region of endemic origin, west and central Africa. Our analysis includes 56 new and highly diverse HCV isolates sampled from infected individuals in Guinea-Bissau. By combining phylogenetic, geographical and epidemiological information, we find a previously unappreciated geographical structure in the diversity of HCV genotype 2, pointing to a history of eastwards spatial spread from the west African coast to Cameroon that took place over several centuries. Molecular clock analysis dates the common ancestor of HCV in Guinea-Bissau to 1470 (1414-1582). The phylogenetic position of isolates from Madagascar and Martinique suggests a role for the historical slave trade in the global dissemination of HCV and of the epidemic subtypes 2a and 2c. Coalescent-based estimates of epidemic growth indicate a rapid 20th-century spread of HCV genotype 2 in Cameroon that is absent in Guinea-Bissau. We discuss this contrast in the context of possible parenteral HCV exposure during public-health campaigns undertaken during the colonial era.

Objective: To evaluate the impact of Mycoplasma genitalium on the outcome of pregnancy. Methods: Cervical samples from women who had previously participated in a case-control study (designed to assess the impact of syphilis and HIV-2 on the outcome of pregnancy in Guinea-Bissau) were processed using a PCR assay to detect the presence of M genitalium. Controls were women who had delivered a term neonate with a birth weight over 2500 g. Cases were classified into four groups of mothers according to the outcome of pregnancy: stillbirths, spontaneous abortions, premature deliveries, and small for gestational age (SGA) babies. Results: Among the 1014 women included in this study, 6.2% were infected with M genitalium. M genitalium infection was not significantly associated with any of the adverse outcomes of pregnancy studied. Odds ratios (OR) for premature or SGA delivery in the presence of M genitalium infection were 1.37 (95% CI 0.69 to 2.60) and 0.44 (95% CI 0.01 to 2.75), respectively. For abortions and stillbirths, OR were respectively 0.61 (95% CI 0.07 to 2.51) and 1.07 (95% CI 0.42 to 2.42). Conclusion: M genitalium appears not to have a deleterious impact on the outcome of pregnancy.M ycoplasma genitalium has recently been shown to be strongly associated with non-gonococcal urethritis (NGU) in developed and developing countries, and increasing evidence supports the role of this organism in the aetiology of NGU. [1][2][3][4] This pathogen has also been detected by polymerase chain reaction (PCR) in the lower genital tract of 7-20% of women attending sexually transmitted diseases (STD) clinics.1 5 M genitalium was found in seven (6.6%) of 106 women with chlamydia negative cervicitis or adnexitis but in none of 80 pregnant asymptomatic women. 6 The involvement of M genitalium in pelvic inflammatory disease (PID) remains unclear: it adheres to fallopian tube epithelial cells in culture 1 and produces salpingitis in animal models, 1 but more studies in women are needed. 4 The role of M genitalium in maternal infections and its impact on the outcome of pregnancy has only been sparsely evaluated. The first published study conducted among pregnant women failed to detect this organism by culture and PCR in 232 samples of amniotic fluid collected at the time of caesarean delivery.7 More recently, M genitalium was found in only 5/124 women who delivered prematurely and its presence in the vagina at mid-trimester was not found to be associated with subsequent spontaneous preterm birth. 8 We have developed a modified version of Jensen's PCR method for the detection of M genitalium 5 to study the aetiology of urethral discharge in sub-Saharan Africa.2 3 To elucidate the potential contribution of M genitalium to adverse outcomes of pregnancy, we used the same PCR assay to detect the presence of M genitalium in cervical secretions of women who had participated in a study initially designed to assess the impact of syphilis and HIV-2 on the outcome of pregnancy in west Africa. METHODSFrom June 1997 to April 1998, we conducted...

A method that avoids culture was devised to determine serovars of Chlamydia trachomatis. Polymerase chain reaction was used first to amplify a part of the chlamydial genome that included the leader sequence and all four variable domains of the major outer membrane protein (MOMP) of the 15 serovars of C. trachomatis. The amplified DNA was then digested simultaneously with restriction endonucleases AluI and MspI and the resulting fragments separated on 10% polyacrylamide gels. After silver staining, a total of 13 characteristic patterns were observed for the 15 serovars, leaving two ambiguities that were resolved using alternate enzymes. Analysis of 40 clinical isolates revealed patterns indistinguishable from those of the prototype serovars including, unexpectedly, 5 Ba serovars. The same PCR procedure also allowed amplification of the MOMP gene of two avian Chlamydia psittaci and one Chlamydia pneumoniae isolates.