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Microbiology (Reading, England) Jan 2020is a fastidious organism of the class the smallest prokaryote capable of independent replication. First isolated in 1981, much is still unknown regarding its natural... (Review)
Review
is a fastidious organism of the class the smallest prokaryote capable of independent replication. First isolated in 1981, much is still unknown regarding its natural history in untreated infection. It is recognized as a sexually transmitted pathogen causing acute and chronic non-gonococcal urethritis (NGU) in men, with a growing body of evidence to suggest it also causes cervicitis and pelvic inflammatory disease in women. Its role in several other clinical syndromes is uncertain. The majority of people infected remain asymptomatic and clear infection without developing disease; asymptomatic screening is therefore not recommended. Prevalence rates are higher in patients attending sexual health clinics and in men with NGU. Limited availability of diagnostics has encouraged syndromic management, resulting in widespread antimicrobial resistance and given that few antimicrobial classes have activity against , there is significant concern regarding the emergence of untreatable strains. There is a need for wider availability of testing, which should include detection of macrolide resistance mediating mutations. Expertise in interpretation of microbiological results with clinical correlation ensures targeted treatment avoiding unnecessary antibiotic exposure. Public health surveillance nationally and internationally is vital in monitoring and responding to changing epidemiology trends. In this review, we summarize current knowledge of , including epidemiology, clinical and microbiological data, and discuss treatment challenges in the era of rising multidrug resistance.
Topics: Anti-Bacterial Agents; Drug Resistance, Bacterial; Humans; Mycoplasma Infections; Mycoplasma genitalium; Prevalence; Public Health Surveillance; Risk Factors; Sexually Transmitted Diseases, Bacterial; Urethritis
PubMed: 31329090
DOI: 10.1099/mic.0.000830 -
MMWR. Recommendations and Reports :... Jun 2015These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of...
These guidelines for the treatment of persons who have or are at risk for sexually transmitted diseases (STDs) were updated by CDC after consultation with a group of professionals knowledgeable in the field of STDs who met in Atlanta on April 30-May 2, 2013. The information in this report updates the Sexually Transmitted Diseases Treatment Guidelines, 2010 (MMWR Recomm Rep 2010;59 [No. RR-12]). These updated guidelines discuss 1) alternative treatment regimens for Neisseria gonorrhoeae; 2) the use of nucleic acid amplification tests for the diagnosis of trichomoniasis; 3) alternative treatment options for genital warts; 4) the role of Mycoplasma genitalium in urethritis/cervicitis and treatment-related implications; 5) updated HPV vaccine recommendations and counseling messages; 6) the management of persons who are transgender; 7) annual testing for hepatitis C in persons with HIV infection; 8) updated recommendations for diagnostic evaluation of urethritis; and 9) retesting to detect repeat infection. Physicians and other health-care providers can use these guidelines to assist in the prevention and treatment of STDs.
Topics: Complementary Therapies; Condylomata Acuminata; Counseling; Female; Gonorrhea; HIV Infections; Hepatitis C; Humans; Male; Mass Screening; Mycoplasma genitalium; Nucleic Acid Amplification Techniques; Papillomavirus Infections; Papillomavirus Vaccines; Recurrence; Sexually Transmitted Diseases; Transgender Persons; Trichomonas Infections; Urethritis; Uterine Cervicitis
PubMed: 26042815
DOI: No ID Found -
Journal of Clinical Microbiology Mar 2023Mycoplasma genitalium is an important sexually transmitted pathogen affecting both men and women. Its extremely slow growth and very demanding culture requirements... (Review)
Review
Mycoplasma genitalium is an important sexually transmitted pathogen affecting both men and women. Its extremely slow growth and very demanding culture requirements necessitate the use of molecular-based diagnostic tests for its detection in clinical specimens. The recent availability of U.S. Food and Drug Administration (FDA)-cleared commercial molecular-based assays has enabled diagnostic testing to become more widely available in the United States and no longer limited to specialized reference laboratories. Advances in the knowledge of the epidemiology and clinical significance of M. genitalium as a human pathogen made possible by the availability of molecular-based testing have led to updated guidelines for diagnostic testing and treatment that have been published in various countries. This review summarizes the importance of M. genitalium as an agent of human disease, explains the necessity of obtaining a microbiological diagnosis, describes currently available diagnostic methods, and discusses how the emergence of antimicrobial resistance has complicated treatment alternatives and influenced the development of diagnostic tests for resistance detection, with an emphasis on developments over the past few years.
Topics: Male; Humans; Female; Anti-Bacterial Agents; Mycoplasma genitalium; Laboratories; Drug Resistance, Bacterial; Mycoplasma Infections; Macrolides; Urethritis
PubMed: 36598247
DOI: 10.1128/jcm.00790-21 -
Revista Espanola de Quimioterapia :... Jun 2021Within Mycoplasma genus, M. pneumoniae, M. genitalium, M. hominis or U. urealyticum are the main species that have been traditionally linked to infectious processes.... (Review)
Review
Within Mycoplasma genus, M. pneumoniae, M. genitalium, M. hominis or U. urealyticum are the main species that have been traditionally linked to infectious processes. However, there are many other species involved in these conditions and that are, frequently, unfamiliar to healthcare professionals. The aim of this review is to identify all Mycoplasma genus species that have been isolated in human beings and to determine their involvement in infectious pathology.
Topics: Humans; Mycoplasma; Mycoplasma Infections; Mycoplasma genitalium; Mycoplasma hominis; Ureaplasma Infections; Ureaplasma urealyticum
PubMed: 33735544
DOI: 10.37201/req/014.2021 -
Clinical Microbiology and Infection :... Jan 2019The vaginal microbiota may modulate susceptibility to human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections.... (Meta-Analysis)
Meta-Analysis
The vaginal microbiota and its association with human papillomavirus, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections: a systematic review and meta-analysis.
BACKGROUND
The vaginal microbiota may modulate susceptibility to human papillomavirus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections. Persistent infection with a carcinogenic HPV is a prerequisite for cervical cancer, and C. trachomatis, N. gonorrheae and M. genitalium genital infections are all associated with pelvic inflammatory disease and subsequent infertility issues.
OBJECTIVES
To evaluate the association between these infections and the vaginal microbiota.
DATA SOURCES
The search was conducted on Medline and the Web of Science for articles published between 2000 and 2016.
STUDY ELIGIBILITY CRITERIA
Inclusion criteria included a measure of association for vaginal microbiota and one of the considered STIs, female population, cohort, cross-sectional and interventional designs, and the use of PCR methods for pathogen detection.
METHODS
The vaginal microbiota was dichotomized into high-Lactobacillus vaginal microbiota (HL-VMB) and low-Lactobacillus vaginal microbiota (LL-VMB), using either Nugent score, Amsel's criteria, presence of clue cells or gene sequencing. A random effects model assuming heterogeneity among the studies was used for each STI considered.
RESULTS
The search yielded 1054 articles, of which 39 met the inclusion criteria. Measures of association with LL-VMB ranged from 0.6 (95% CI 0.3-1.2) to 2.8 (95% CI 0.3-28.0), 0.7 (95% CI 0.4-1.2) to 5.2 (95% CI 1.9-14.8), 0.8 (95% CI 0.5-1.4) to 3.8 (95% CI 0.4-36.2) and 0.4 (95% CI 0.1-1.5) to 6.1 (95% CI 2.0-18.5) for HPV, C. trachomatis, N. gonorrhoeae and M. genitalium infections, respectively.
CONCLUSIONS
Although no clear trend for N. gonorrhoeae and M. genitalium infections could be detected, our results support a protective role of HL-VMB for HPV and C. trachomatis. Overall, these findings advocate for the use of high-resolution characterization methods for the vaginal microbiota and the need for longitudinal studies to lay the foundation for its integration in prevention and treatment strategies.
Topics: Chlamydia Infections; Chlamydia trachomatis; Female; Gonorrhea; Humans; Microbial Interactions; Microbiota; Mycoplasma Infections; Mycoplasma genitalium; Neisseria gonorrhoeae; Papillomaviridae; Pelvic Inflammatory Disease; Sexually Transmitted Diseases; Vagina
PubMed: 29729331
DOI: 10.1016/j.cmi.2018.04.019 -
Clinical Microbiology and Infection :... May 2022We evaluated the clinical performances of four multiplex real-time PCR commercial kits for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma...
OBJECTIVES
We evaluated the clinical performances of four multiplex real-time PCR commercial kits for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium and Trichomonas vaginalis: the STI PLUS ELITe MGB kit (ELITechGroup), N. gonorrhoeae/C. trachomatis/M. genitalium/T.vaginalis Real-TM kit (Sacace Biotechnologies), Allplex STI Essential kit (Seegene), and FTD Urethritis Plus kit (Fast-Track Diagnostics).
METHODS
The kit performance for C. trachomatis, N. gonorrhoeae, M. genitalium and T. vaginalis detection was compared to that of the cobas CT/NG and TV/MG kits (Roche Diagnostics) using 425 samples, mainly urine and cervicovaginal, throat and rectal swabs. Detection of Ureaplasma parvum, U. urealyticum and Mycoplasma hominis were compared to that of in-house TaqMan PCRs.
RESULTS
The four kits showed good performances for the detection of C. trachomatis. They all presented a low positive agreement for the detection of M. genitalium and T. vaginalis (ranges 63.3-74.1% and 51.2-68.4%, respectively) compared to the cobas MG/TV kit. The Seegene and Sacace kits showed additional low positive agreement for the detection of N. gonorrhoeae (71.2%, 95%CI 61.8-79.0 and 63.1%, 95%CI 53.5-71.8, respectively). We observed a slight but significant lower negative agreement for N. gonorrhoeae detection using the ELITechGroup kit (92.5%, 89.1-94.9) and for M. genitalium detection using the Fast-Track kit (93.2%, 89.6-95.7) compared to other kits.
CONCLUSION
Multiplex real-time PCR kits are convenient methods for the detection of several pathogens associated with sexually transmitted infections (STIs) in a single step, but colonizing Ureaplasma spp. and M. hominis species should not be included in these kits. Users should be aware of the weak performance of some kits for the detection of M. genitalium and T. vaginalis.
Topics: Chlamydia trachomatis; Female; Gonorrhea; Humans; Male; Mycoplasma Infections; Mycoplasma genitalium; Neisseria gonorrhoeae; Real-Time Polymerase Chain Reaction; Sexually Transmitted Diseases; Trichomonas vaginalis; Ureaplasma; Urethritis
PubMed: 34610459
DOI: 10.1016/j.cmi.2021.09.028 -
Clinical Infectious Diseases : An... Apr 2021Anaerobic organisms are important pathogens in acute pelvic inflammatory disease (PID). The currently recommended PID regimen of a single dose of ceftriaxone and... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Anaerobic organisms are important pathogens in acute pelvic inflammatory disease (PID). The currently recommended PID regimen of a single dose of ceftriaxone and doxycycline for 14 days has limited anaerobic activity. The need for broader anaerobic coverage is unknown and concerns have been raised about metronidazole tolerability.
METHODS
We conducted a randomized, double-blind, placebo-controlled trial comparing ceftriaxone 250 mg intramuscular single dose and doxycycline for 14 days, with or without 14 days of metronidazole in women with acute PID. The primary outcome was clinical improvement at 3 days following enrollment. Additional outcomes at 30 days following treatment were the presence of anaerobic organisms in the endometrium, clinical cure (absence of fever and reduction in tenderness), adherence, and tolerability.
RESULTS
We enrolled 233 women (116 to metronidazole and 117 to placebo). Clinical improvement at 3 days was similar between the 2 groups. At 30 days following treatment, anaerobic organisms were less frequently recovered from the endometrium in women treated with metronidazole than placebo (8% vs 21%, P < .05) and cervical Mycoplasma genitalium was reduced (4% vs 14%, P < .05). Pelvic tenderness was also less common among women receiving metronidazole (9% vs 20%, P < .05). Adverse events and adherence were similar in each treatment group.
CONCLUSIONS
In women treated for acute PID, the addition of metronidazole to ceftriaxone and doxycycline was well tolerated and resulted in reduced endometrial anaerobes, decreased M. genitalium, and reduced pelvic tenderness compared to ceftriaxone and doxycycline. Metronidazole should be routinely added to ceftriaxone and doxycycline for the treatment of women with acute PID.
CLINICAL TRIALS REGISTRATION
NCT01160640.
Topics: Anti-Bacterial Agents; Ceftriaxone; Doxycycline; Female; Humans; Metronidazole; Mycoplasma genitalium; Pelvic Inflammatory Disease
PubMed: 32052831
DOI: 10.1093/cid/ciaa101 -
Virulence Dec 2022, a pathogen from class Mollicutes, has been linked to sexually transmitted diseases and sparked widespread concern. To adapt to its environment, has evolved specific... (Review)
Review
, a pathogen from class Mollicutes, has been linked to sexually transmitted diseases and sparked widespread concern. To adapt to its environment, has evolved specific adhesins and motility mechanisms that allow it to adhere to and invade various eukaryotic cells, thereby causing severe damage to the cells. Even though traditional exotoxins have not been identified, secreted nucleases or membrane lipoproteins have been shown to cause cell death and inflammatory injury in infection. However, as both innate and adaptive immune responses are important for controlling infection, the immune responses that develop upon infection do not necessarily eliminate the organism completely. Antigenic variation, detoxifying enzymes, immunoglobulins, neutrophil extracellular trap-degrading enzymes, cell invasion, and biofilm formation are important factors that help the pathogen overcome the host defence and cause chronic infections in susceptible individuals. Furthermore, can increase the susceptibility to several sexually transmitted pathogens, which significantly complicates the persistence and chronicity of infection. This review aimed to discuss the virulence factors of to shed light on its complex pathogenicity and pathogenesis of the infection.
Topics: Adhesins, Bacterial; Humans; Mycoplasma Infections; Mycoplasma genitalium; Virulence; Virulence Factors
PubMed: 35791283
DOI: 10.1080/21505594.2022.2095741 -
CMAJ : Canadian Medical Association... Jan 2019
Topics: Anti-Bacterial Agents; Azithromycin; Canada; Drug Resistance, Bacterial; Female; Fluoroquinolones; Health Surveys; Humans; Male; Moxifloxacin; Mycoplasma Infections; Mycoplasma genitalium; Practice Guidelines as Topic; Prevalence; Sexually Transmitted Diseases, Bacterial
PubMed: 30692107
DOI: 10.1503/cmaj.180881 -
Antimicrobial Agents and Chemotherapy Apr 2023Mycoplasma genitalium is a sexually transmitted reproductive tract pathogen of men and women. M. genitalium infections are increasingly difficult to treat due to poor...
Mycoplasma genitalium is a sexually transmitted reproductive tract pathogen of men and women. M. genitalium infections are increasingly difficult to treat due to poor efficacy of doxycycline and acquired resistance to azithromycin and moxifloxacin. A recent clinical trial suggested that metronidazole may improve cure rates for women with pelvic inflammatory disease and reduced the detection of M. genitalium when included with standard doxycycline plus ceftriaxone treatment. As data regarding susceptibility of mycoplasmas to nitroimidazoles are lacking in the scientific literature, we determined the susceptibility of 10 M. genitalium strains to metronidazole, secnidazole, and tinidazole. MICs ranged from 1.6 to 12.5 μg/mL for metronidazole, 3.1 to 12.5 μg/mL for secnidazole, and 0.8 to 6.3 μg/mL for tinidazole. None of these agents was synergistic with doxycycline in checkerboard broth microdilution assays. Tinidazole was superior to metronidazole and secnidazole in terms of MIC and time-kill kinetics and was bactericidal (>99.9% killing) at concentrations below reported serum concentrations. Mutations associated with nitroimidazole resistance were identified by whole-genome sequencing of spontaneous resistant mutants, suggesting a mechanism for reductive activation of the nitroimidazole prodrug by a predicted NAD(P)H-dependent flavin mononucleotide (FMN) oxidoreductase. The presence of oxygen did not affect MICs of wild-type M. genitalium, but a nitroimidazole-resistant mutant was defective for growth under anaerobic conditions, suggesting that resistant mutants may have a fitness disadvantage in anaerobic genital sites. Clinical studies are needed to determine if nitroimidazoles, especially tinidazole, are effective for eradicating M. genitalium infections in men and women.
Topics: Male; Female; Humans; Nitroimidazoles; Doxycycline; Metronidazole; Tinidazole; Mycoplasma genitalium; Anti-Bacterial Agents; Mycoplasma Infections; Drug Resistance, Bacterial
PubMed: 37070857
DOI: 10.1128/aac.00006-23