Natural history of Mycoplasma genitalium Infection in a Cohort of Female Sex Workers in Kampala, Uganda

Vandepitte, J; Weiss, Helen A.; Kyakuwa, Nassim; Nakubulwa, Susan; Müller, Etienne; Buvé, Anne; Stuyft, Patrick Van der; Hayes, Richard; Grosskurth, Heiner

doi:10.1097/olq.0b013e31828bfccf

Cited by 58 publications

(69 citation statements)

References 28 publications

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“…genitalium infection can persist for months to years in infected patients (12)(13)(14)(15)(16)(17)(18)(19), despite the presence of antibodies to M. genitalium in genital exudates of infected women (20) and in the sera of infected men (21). These data suggest that M. genitalium evades the local and systemic immune response, potentially increasing the likelihood of sexual transmission and ascension to the upper reproductive tract.…”

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confidence: 85%

“…For example, M. genitalium persisted in the lower genital tract for Ͼ2 to 3 months in 50% of enrolled Kenyan and Ugandan sex workers (12,14) and for Ͼ12 to 21 months in 26% of students studied in London (41). Persistent M. genitalium infection has been established in other animal models, including vaginally infected chimpanzees (42), urethrally inoculated male chimpanzees (43), and the upper reproductive tracts of vaginally infected mice (44).…”

Section: Discussionmentioning

confidence: 99%

“…Persistence of M. genitalium cervical infection for Ͼ8 weeks in four (44%) primates mimics untreated infection in men and women (12,14,16,(39)(40)(41). For example, M. genitalium persisted in the lower genital tract for Ͼ2 to 3 months in 50% of enrolled Kenyan and Ugandan sex workers (12,14) and for Ͼ12 to 21 months in 26% of students studied in London (41).…”

Section: Discussionmentioning

confidence: 99%

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Experimental Infection of Pig-Tailed Macaques (Macaca nemestrina) with Mycoplasma genitalium

et al. 2017

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Mycoplasma genitalium is an underappreciated cause of human reproductive tract disease, characterized by persistent, often asymptomatic, infection. Building on our previous experiments using a single female pig-tailed macaque as a model for Cosgrove Sweeney, and P. A. Totten, Infect Immun 81:2938 -2951, https://doi.org/10.1128/IAI.01322-12), we cervically inoculated eight additional animals, two of which were simultaneously inoculated in salpingeal tissue autotransplanted into abdominal pockets. Viable M. genitalium persisted in the lower genital tract for 8 weeks in three animals, 4 weeks in two, and 1 week in one; two primates resisted infection. In both animals inoculated in salpingeal pockets, viable M. genitalium was recovered for 2 weeks. Recovery of viable M. genitalium from lower genital tract specimens was improved by diluting the specimen in broth and by Vero cell coculture. Ascension to upper reproductive tract tissues was not detected, even among three persistently infected animals. M. genitalium-specific serum antibodies targeting the immunodominant MgpB and MgpC proteins appeared within 1 week in three animals inoculated both cervically and in salpingeal pockets and in one of three persistently infected animals inoculated only in the cervix. M. genitaliumspecific IgG, but not IgA, was detected in cervical secretions of serum antibodypositive animals, predominantly against MgpB and MgpC, but was insufficient to clear M. genitalium lower tract infection. Our findings further support female pigtailed macaques as a model of M. genitalium infection, persistence, and immune evasion. KEYWORDS Mycoplasma genitalium, animal model, antibody response, persistent infection, primateM ycoplasma genitalium is a fastidious, cell wall-less bacterium notable for its small size (0.1 m), reduced genome (580 kbp), parasitic lifestyle, and apparent specificity for the human host. In men, M. genitalium is a frequent cause of acute and chronic nonchlamydial nongonococcal urethritis (1-4), and in women, M. genitalium is increasingly recognized for its role in cervicitis, pelvic inflammatory disease, preterm birth, and spontaneous abortion (reviewed in reference 5). Additional studies have implicated M. genitalium in tubal factor infertility (6, 7) and endometritis (8). Significantly, M. genitalium infection increases cervical shedding (9) and the risk of acquiring and transmitting HIV (10, 11), further highlighting the potential adverse outcomes resulting from this underappreciated bacterial pathogen.M. genitalium infection can persist for months to years in infected patients (12-19), despite the presence of antibodies to M. genitalium in genital exudates of infected women (20) and in the sera of infected men (21). These data suggest that M. genitalium

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confidence: 85%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Experimental Infection of Pig-Tailed Macaques (Macaca nemestrina) with Mycoplasma genitalium

et al. 2017

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“…M. genitalium may also increase the risk of HIV transmission and associated shedding (10)(11)(12)(13).…”

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Clinical Characteristics Associated with Mycoplasma genitalium among Female Sex Workers in Nairobi, Kenya

et al. 2014

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eThe prevalence of Mycoplasma genitalium is high in vulnerable populations of women in low-resource settings. However, the epidemiology of infection in these populations is not well established. To determine the prevalence of Mycoplasma genitalium and its association with cervical cytology and other correlates, we recruited 350 female sex workers (FSW) who were 18 to 50 years old in Nairobi, Kenya, for a cross-sectional study. A questionnaire was administered at baseline to obtain information on sociodemographics and sexual behaviors. Women underwent a pelvic exam, during which a physician collected cervical-exfoliation samples for conventional cytology and sexually transmitted infection (STI) testing. Samples were tested for M. genitalium Mycoplasma genitalium is an emergent bacterium that is transmitted via sexual activity and has been associated with complications in the female genital tract, including endometritis, tubal-factor infertility, pelvic inflammatory disease (PID), cervicitis, and ectopic pregnancy (1-9). M. genitalium may also increase the risk of HIV transmission and associated shedding (10-13).Vulnerable populations of women in low-resource settings have a higher-than-average susceptibility to sexually transmitted infections (STIs) and subsequent complications of the reproductive tract, including those caused by M. genitalium, Chlamydia trachomatis, and Neisseria gonorrhoeae (14). In the case of female sex workers (FSWs), STI risk is increased due to a greater exposure to unsafe sexual behaviors, such as unprotected sexual intercourse and high numbers of clients/sexual partners (15).The prevalence and associated risk factors for M. genitalium have been investigated both in the general population and among populations at high risk for STIs in sub-Saharan Africa, Asia, the United Kingdom, and the United States (4, 16-23). Across many of these studies, a young age, little education, single marital status, and high numbers of sex partners remained consistently associated with infection (4,9,16,18,21,23,24). Findings are less consistent among the few studies that examined risk factors among FSWs. In the literature, studies have shown similar associations of M. genitalium infection with basic demographic factors, such as education and marital status. However, there is less agreement for sexual-behavioral and clinical correlates, such as condom use, duration of sex work, and history of STIs (16,18,23). Chinese sex workers who did not present STI symptoms in the year prior to the study were more likely to have infection with M. genitalium than those who did (23). In contrast, a study conducted in sub-Saharan Africa found that sex workers who presented clinical symptoms were more likely to have M. genitalium infection than those who were asymptomatic (18).In studies examining concurrent M. genitalium infection with other STIs in the general population, M. genitalium was found to be associated with urethritis, cervicitis, and PID (25-28). However, more-recent research indicates the role of M. genitalium ...

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“…Although oralurethral transmission of MG has not been proven, this case raises questions about this route of infection. 1,2 In the present case, we propose that the apparent treatment failure might represent macrolide resistance in this patient. 3 Moreover, this might be present in the local population in Lebanon but further work with a large series of patients is warranted to investigate MG prevalence and resistance rate estimation.…”

Section: Commentmentioning

confidence: 95%

Mycoplasma genitalium: a possible case of macrolide resistance from Lebanon

Maatouk

2016

Int J STD AIDS

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Natural history of Mycoplasma genitalium Infection in a Cohort of Female Sex Workers in Kampala, Uganda

Cited by 58 publications

References 28 publications

Experimental Infection of Pig-Tailed Macaques (Macaca nemestrina) with Mycoplasma genitalium

Experimental Infection of Pig-Tailed Macaques (Macaca nemestrina) with Mycoplasma genitalium

Clinical Characteristics Associated with Mycoplasma genitalium among Female Sex Workers in Nairobi, Kenya

Mycoplasma genitalium: a possible case of macrolide resistance from Lebanon

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