Mycoplasma genitalium Infection in Men
Mycoplasma genitalium Infection in Men
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DOI：
10.1093/infdis/jix145
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发表时间：
2017-07-15
影响因子：
6.4
通讯作者：
Martin, David H.
中科院分区：
文献类型：
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作者：
Horner, Patrick J.;Martin, David H.
生殖支原体是全世界非淋菌性尿道炎 (NGU) 的主要原因之一，但在普通人群中是一种罕见的性传播感染 (STI)。性传播的风险可能低于沙眼衣原体。男性感染通常无症状，大多数男性很可能在感染后痊愈而不会发病。由生殖支原体引起的 NGU 的潜伏期可能比由沙眼衣原体引起的 NGU 长。有症状的 NGU 的临床特征尚未被证明可以确定病原体的具体病因。男性及其性伴侣的有效治疗很复杂，因为大环内酯类抗生素耐药性现在在许多国家很常见，这可能是由于广泛使用阿奇霉素 1 g 来治疗性传播感染以及生殖支原体诊断测试的有限性所致。引入诊断性生殖支原体核酸扩增检测，包括对有 NGU 症状的男性及其当前性伴侣进行抗菌药物耐药性检测，可能会改善 NGU 男性的治疗结果，并加强抗菌药物管理。这些方法的成本效益需要进一步评估。生殖支原体引起附睾睾丸炎、直肠炎和反应性关节炎并促进人类免疫缺陷病毒在男性中传播的证据很薄弱，尽管在生物学上是合理的。由于缺乏证明成本效益的随机对照试验，不建议对无症状男性进行筛查。
Mycoplasma genitalium is one of the major causes of nongonococcal urethritis (NGU) worldwide but an uncommon sexually transmitted infection (STI) in the general population. The risk of sexual transmission is probably lower than for Chlamydia trachomatis. Infection in men is usually asymptomatic and it is likely that most men resolve infection without developing disease. The incubation period for NGU caused by Mycoplasma genitalium is probably longer than for NGU caused by C. trachomatis. The clinical characteristics of symptomatic NGU have not been shown to identify the pathogen specific etiology. Effective treatment of men and their sexual partner(s) is complicated as macrolide antimicrobial resistance is now common in many countries, conceivably due to the widespread use of azithromycin 1 g to treat STIs and the limited availability of diagnostic tests for M. genitalium. Improved outcomes in men with NGU and better antimicrobial stewardship are likely to arise from the introduction of diagnostic M. genitalium nucleic acid amplification testing including antimicrobial resistance testing in men with symptoms of NGU as well as in their current sexual partner(s). The cost effectiveness of these approaches needs further evaluation. The evidence that M. genitalium causes epididy-mo-orchitis, proctitis, and reactive arthritis and facilitates human immunodeficiency virus transmission in men is weak, although biologically plausible. In the absence of randomized controlled trials demonstrating cost effectiveness, screening of asymptomatic men cannot be recommended.