The association between <i>Mycoplasma genitalium</i> and pelvic inflammatory disease after termination of pregnancy

Bjartling, Carina; Osser, Stellan; Persson, Kenneth

doi:10.1111/j.1471-0528.2009.02455.x

Cited by 81 publications

(58 citation statements)

References 8 publications

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“…The first evidence of an association came from a Japanese study, reported in 1997 (225), in which M. genitalium was detected in the cervices of 5 (9%) of 57 women with cervicitis but in none of 79 women without the condition. Subsequently, the results of other studies (2,4,11,23,48,57,80,89,137,139,148,163,165,225), shown in Fig. 5, to a large extent attest to M. genitalium having a significant role in causing cervicitis.…”

Section: Cervicitismentioning

confidence: 95%

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

2011

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SUMMARY The history, replication, genetics, characteristics (both biological and physical), and factors involved in the pathogenesis of Mycoplasma genitalium are presented. The latter factors include adhesion, the influence of hormones, motility, possible toxin production, and immunological responses. The preferred site of colonization, together with current detection procedures, mainly by PCR technology, is discussed. The relationships between M. genitalium and various diseases are highlighted. These diseases include acute and chronic nongonococcal urethritis, balanoposthitis, chronic prostatitis, and acute epididymitis in men and urethritis, bacterial vaginosis, vaginitis, cervicitis, pelvic inflammatory disease, and reproductive disease in women. A causative relationship, or otherwise strong association, between several of these diseases and M. genitalium is apparent, and the extent of this, on a subjective basis, is presented; also provided is a comparison between M. genitalium and two other genital tract-orientated mollicutes, namely, Mycoplasma hominis , the first mycoplasma of human origin to be discovered, and Ureaplasma species. Also discussed is the relationship between M. genitalium and infertility and also arthritis in both men and women, as is infection in homosexual and immunodeficient patients. Decreased immunity, as in HIV infections, may enhance mycoplasmal detection and increase disease severity. Finally, aspects of the antimicrobial susceptibility and resistance of M. genitalium , together with the treatment and possible prevention of mycoplasmal disease, are discussed.

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Section: Cervicitismentioning

confidence: 95%

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

2011

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“…Data on the prevalence of NG infection in the general population do not seem to exist. Studies based on females undergoing TOP in a hospital setting mentioned infection rates as follows: CT 2.8% to 15.74%; MG 0.98% to 8.7%; NG 0.67% to 3% (12,(15)(16)(17)(18). Reasons for these wide ranges are multifarious, e.g.…”

Section: ü1 Introductionmentioning

confidence: 99%

Prevalence and Determinants of Sexually Transmitted Infections in Women at Risk Undergoing Abortion in a Swiss Primary Care Setting

Wesbonk

Chmiel

Rosemann

et al. 2014

Praxis

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Background: Specific prevalence data are needed to assess the burden of sexually transmitted infections (STIs) in specific settings where data are scant, such as women seeking early termination of pregnancy (TOP). We aimed to investigate the prevalence of STIs and its determinants in women at risk (e.g. pathological cervical swab) undergoing TOP in a primary care setting in Switzerland.Methods: Cross-sectional study of 620 women seeking abortion counselling at a general practice in Zurich, Switzerland.. Patients' characteristics were assessed and in case of pathological cervical swab a PCR-based screening for Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Neisseria gonorrhoeae (NG) was initiated to estimate STI prevalence. Bi-and multivariable analysis were used to investigate STI determinants.Results: 585 out of the 620 women presenting for counselling resulted in TOP. 581 (93.7%) cervical specimens were available with 272 having pathological signs (46.8%), thus were considered at risk for STIs. In 192 screened samples 28 STIs (14.6%) (95% CI: 10.3-20.3%) were detected, predominantly CT (17 cases) followed by MG (9 cases) and NG (2 cases).Compared to non-immigrants, immigrants were more likely to have a STI (adjusted OR 2.63; p=0.037) Non-screened women were significantly more often self-payers (31.3%) compared to screened women (8.3%) (p<0.001). Conclusion:We found a high STI prevalence in women presenting for TOP in a Swiss primary care setting. Women with a migration background seemed to be a vulnerable subgroup. Public health efforts are needed to implement cost-effective screening and case management programs in this population at risk for STIs. 2 Ü1 Abbreviations Ü1 IntroductionSexually transmitted infections (STI) are among the most common causes of illness in the world and have far-reaching health, social and economic consequences for many countries.Chlamydia trachomatis (CT), Mycoplasma genitalium (MG) and Neisseria gonorrhoeae (NG) are considered being common sexually transmitted pathogens and can cause genitourinary infections with a wide range of symptoms; in women MG and NG can cause cervicitis, urethritis and endometritis (1-5). The causal connection of MG with salpingitis as well as potentially resulting infertility remains controversial, whereas CT and NG are known to cause salpingitis and have an impact on infertility (1, 4,(6)(7)(8)(9)(10)). An untreated CT infection can also lead to peritonitis, perihepatitis, pelvic inflammatory disease (PID) and ectopic pregnancy (EP) (4, 6, 7). Genital CT and NG infections are asymptomatic or just show mild symptoms in up to 70% and 50% of cases, respectively (4, 11). As a consequence, these infections often remain undetected thus abetting further transmission. Similarly, asymptomatic MG infections have also been described, raising the question whether also asymptomatic subgroups, such as women presenting for early termination of pregnancy (TOP), should be screened for MG (12, 13).International prevalence rates of STIs vary, depe...

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“…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).…”

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confidence: 99%

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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The association between Mycoplasma genitalium and pelvic inflammatory disease after termination of pregnancy

Cited by 81 publications

References 8 publications

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly

Prevalence and Determinants of Sexually Transmitted Infections in Women at Risk Undergoing Abortion in a Swiss Primary Care Setting

Fluoroquinolone and Macrolide Resistance-Associated Mutations in Mycoplasma genitalium

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