Mycoplasma genitalium as a Contributor to the Multiple Etiologies of Cervicitis in Women Attending Sexually Transmitted Disease Clinics

Gaydos, Charlotte A.; Maldeis, Nancy E.; Hardick, Andrew; Hardick, Justin; Quinn, Thomas C.

doi:10.1097/olq.0b013e3181b01948

Cited by 124 publications

(120 citation statements)

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“…In the realm of laboratory diagnosis, initial studies of target capture-based transcription-mediated amplification (TMA) in females reported 87.8% (14) We recently demonstrated the utility of TMA-based M. genitalium detection in male specimens originating from both STI and community outpatient clinics (16). In contrast, previous studies of M. genitalium TMA in females have largely focused on high-risk demographics (14,15,(17)(18)(19). Assessment of M. genitalium detection rates in a communitywide setting would be beneficial.…”

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confidence: 75%

Clinical Laboratory Assessment of Mycoplasma genitalium Transcription-Mediated Amplification Using Primary Female Urogenital Specimens

et al. 2016

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Following analysis of primary cervix, vagina, and first-void female urine specimens for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis via commercial transcription-mediated amplification (TMA), residual material was subjected to Mycoplasma genitalium research-use-only TMA. Representation within a 2,478-specimen retrospective study set was established by comparison to a 6-month audit of clinical C. trachomatis TMA (12,999 specimens) on the basis of the C. trachomatis detection rate, specimen source distribution, clinic location, and age. M. genitalium was detected in 282 (11.4%) patients. This rate was higher than those seen with T. vaginalis (9.0%; P ‫؍‬ 0.005), C. trachomatis (6.2%), and N. gonorrhoeae (1.4%). Positive M. genitalium results were confirmed by repeat testing or alternative-target TMA at a rate of 98.7%. The mean age of the M. genitalium-infected females (24.7 years) was lower than that of the T. vaginalis-infected females (mean, 30.1 years; P < 0.0001) and higher than that of the C. trachomatis-infected females (mean, 23.8 years; P ‫؍‬ 0.003). Of 566 patient encounters positive for at least one sexually transmitted infection (STI), 35.9% exhibited sole detection of M. genitalium (P < 0.0004 versus sole detection of other STI agents) and 26.1% were solely positive for T. vaginalis (P < 0.0002 versus C. trachomatis). The M. genitalium and T. vaginalis detection rates among 755 patients at urban emergency departments were 14.6% and 13.0%, respectively (P ‫؍‬ 0.37). A 10.0% M. genitalium detection rate from other facilities exceeded that of T. vaginalis (7.2%; P ‫؍‬ 0.004). Incorporation of M. genitalium TMA into comprehensive testing programs would detect M. genitalium in a significant proportion of females, particularly those in outpatient obstetrics and gynecology (OB/GYN) settings. T he sexually transmitted infection (STI) agentMycoplasma genitalium has historically had a role of pathogenicity in male nongonococcal urethritis (1). Recent evidence has implicated the bacterium in clinically significant disease in females (2, 3). Additional studies suggest that M. genitalium infection promotes HIV acquisition (4-6) and virus shedding (7,8). Moreover, in a recent meta-analysis, Lis et al. (9) reported significant associations between M. genitalium infection and cervicitis, pelvic inflammatory disease, preterm birth, and spontaneous abortion.Until recently, a lack of reliable testing options has curtailed laboratory diagnosis of M. genitalium infection. Culture and serologic modalities have been limited by sensitivity and/or cross-reactivity with other mycoplasmas (1) and are becoming supplanted by molecular diagnostics, largely on a research basis. PCR-based assays have correlated M. genitalium DNA burden with clinical condition (10, 11) and treatment efficacy (12) in males. Quantitative molecular analysis has sought to study progression of genital disease in females (13). In the realm of laboratory diagnosis, initial studies of target capture-based transcription-mediated amp...

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Clinical Laboratory Assessment of Mycoplasma genitalium Transcription-Mediated Amplification Using Primary Female Urogenital Specimens

et al. 2016

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“…are organisms variably present in rest of cases and often called nonspecific cervicitis (NSC) [2,4,9].…”

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confidence: 99%

Effect of Unani Formulation in Cervicitis (Warme-unqur-rahm): A Single-blind Randomized Placebo-controlled Trial

Zahid¹,

Rehman²

2016

Altern Integr Med

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Objective: To evaluate the efficacy and safety of Polyherbal Unani formulations (PHUFs) with placebo in Warmeunqur-rahm (Cervicitis). Methods:A Randomized single-blind placebo controlled trial was designed to compare the efficacy of Unani formulations against placebo in diagnosed cases of cervicitis in the Department of Gynaecology of Ayurvedic & Unani Tibbia College, Delhi. Sixty married female participants with age group of 18-40 years having symptoms of cervicitis with no systemic illness and sexually transmitted diseases and not using oral or intrauterine contraceptives were randomly allocated to receive either test drug (n = 30) or placebo (n = 30) for three months.In the test group, sufoofe sailan (PHUF) 5 gm orally was given twice daily and intravaginally humul (pessary) of isapghol (Isapgol: Plantago ovata Forsk) and alsi (Linseed: Linum usitatissimum L.) soaked in arqe gulab (rose water) was kept at mid-cycle for 10 days for three consecutive cycles and the placebo was given for same protocol. On the basis of improvement in subjective and objective parameters the response of treatment was graded as cured, improved and not cured. Results were analyzed by Chi-square/Fisher Exact test and Student t test. Results:There was a significant improvement in the subjective and objective parameters in test group after treatment with P < 0.001. Cervical discharge, cervical erythema and cervical oedema were significantly reduced (P < 0.001) after three months of treatment. Interpretation and conclusion: Study revealed that test drug formulations were effective and safe in the management of cervicitis. Besides, the trial should be conducted on large sample size for effectiveness of drug.

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“…In men, M. genitalium is a significant cause of both acute and chronic nongonococcal urethritis (NGU) (5)(6)(7) and is estimated to account for 15% to 25% of cases of NGU in some populations (2). In women, M. genitalium has been significantly associated with both cervicitis (2,(8)(9)(10) and pelvic inflammatory disease (2,(11)(12)(13)(14), and it has been identified in up to 7.3% of women in high-risk populations (15). In Australia, M. genitalium has been reported to account for between 4.5% and 9% of cases of NGU (16,17), while it was identified in 4% of women attending a Sydney sexual health clinic and was the second most common cause of cervicitis (9).…”

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Fluoroquinolone and Macrolide Resistance-Associated Mutations in Mycoplasma genitalium

et al. 2013

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dMycoplasma genitalium is a significant sexually transmitted pathogen, causing up to 25% of cases of nongonococcal urethritis in men, and it is strongly associated with cervicitis and pelvic inflammatory disease in women. Currently, the usual first-line treatment is the macrolide antibiotic azithromycin, but an increasing incidence of treatment failure over the last 5 years suggests the emergence of antibiotic resistance. The mutations responsible for macrolide resistance have been found in the 23S rRNA gene in numerous M. genitalium populations. A second-line antibiotic, the fluoroquinolone moxifloxacin, was thought to be a reliable alternative when azithromycin began to fail, but recent studies have identified mutations that may confer fluoroquinolone resistance in the genes parC and gyrA. The aim of this study was to determine the prevalence of antibiotic resistance in M. genitalium in Sydney, Australia, by detecting relevant mutations in the 23S rRNA gene, parC, and gyrA. M. genitalium-positive DNA extracts of specimens, collected from patients attending sexual health clinics in Sydney, were tested by PCR amplification and DNA sequence alignment. The 186 specimens tested included 143 initial patient specimens and 43 second, or subsequent, specimens from 24 patients. We identified known macrolide resistance-associated mutations in the 23S rRNA gene in 43% of the initial patient samples and mutations potentially associated with fluoroquinolone resistance in parC or gyrA sequences in 15% of the initial patient samples. These findings support anecdotal clinical reports of azithromycin and moxifloxacin treatment failures in Sydney. Our results indicate that further surveillance is needed, and testing and treatment protocols for M. genitalium infections may need to be reviewed. Mycoplasma genitalium, one of the smallest known self-replicating organisms (1), is an obligate parasite, preferring the human genital tract as its host environment (2-4). In men, M. genitalium is a significant cause of both acute and chronic nongonococcal urethritis (NGU) (5-7) and is estimated to account for 15% to 25% of cases of NGU in some populations (2). In women, M. genitalium has been significantly associated with both cervicitis (2, 8-10) and pelvic inflammatory disease (2,(11)(12)(13)(14), and it has been identified in up to 7.3% of women in high-risk populations (15). In Australia, M. genitalium has been reported to account for between 4.5% and 9% of cases of NGU (16, 17), while it was identified in 4% of women attending a Sydney sexual health clinic and was the second most common cause of cervicitis (9).The usual treatment regime for clinically diagnosed NGU and cervicitis is a single dose of 1 g azithromycin (AZM) (18). An extended regime (1.5 g over 5 days) is often prescribed if singledose AZM is unsuccessful, but there is contention regarding the effectiveness of this extended treatment (19,20). Alarmingly, studies investigating the effectiveness of either 1 g or 1.5 g AZM treatment have reported microbiological treatment f...

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Mycoplasma genitalium as a Contributor to the Multiple Etiologies of Cervicitis in Women Attending Sexually Transmitted Disease Clinics

Cited by 124 publications

References 44 publications

Clinical Laboratory Assessment of Mycoplasma genitalium Transcription-Mediated Amplification Using Primary Female Urogenital Specimens

Clinical Laboratory Assessment of Mycoplasma genitalium Transcription-Mediated Amplification Using Primary Female Urogenital Specimens

Effect of Unani Formulation in Cervicitis (Warme-unqur-rahm): A Single-blind Randomized Placebo-controlled Trial

Fluoroquinolone and Macrolide Resistance-Associated Mutations in Mycoplasma genitalium

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