Mycoplasma genitalium Infection in Kenyan and US Women
Mycoplasma genitalium Infection in Kenyan and US Women
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DOI：
10.1097/olq.0000000000000799
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发表时间：
2018-08-01
影响因子：
3.1
通讯作者：
McClelland, R. Scott
中科院分区：
文献类型：
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作者：
Balkus, Jennifer E.;Manhart, Lisa E.;McClelland, R. Scott
背景 人们对女性生殖支原体 (MG) 感染的自然史知之甚少。我们回顾性地测试了存档的阴道液体样本，以评估参与预防阴道感染试验的女性中 MG 患病率、发病率、持续性、复发和抗菌素耐药性标志物，该试验是一项每月进行推定治疗以减少阴道感染的随机试验。方法来自肯尼亚和美国的 18 至 45 岁高危、非妊娠、HIV 阴性女性被随机接受甲硝唑 750 mg + 咪康唑 200 mg 阴道内注射每月连续 5 晚使用栓剂或安慰剂，持续 12 个月。在入组时以及此后每隔一个月，使用 Hologic 核酸扩增检测对临床医生收集的含有宫颈阴道液的拭子进行 MG 检测。 MG+ 样本通过 DNA 测序接受了大环内酯类耐药介导突变的额外检测。结果 在 234 名入组女性中，221 人有可用样本，25 人 (11.3%) 在入组时患有 MG。在 196 名入组时未患有 MG 的女性中，有 52 例发生 MG 感染（发病率为每 100 人年 33.4 例）。吸烟与 MG 感染独立相关（调整后风险比，3.02；95% 置信区间，1.32-6.93），年龄小于 25 岁有关联趋势（调整后风险比，1.70；95% 置信区间，0.95-3.06）。 MG 感染事件清除的中位时间为 1.5 个月（四分位数范围，1.4-3.0 个月）。在 120 份 MG+ 标本中，来自 15 名不同女性的 16 份标本呈大环内酯类耐药介导的突变阳性（13.3%），各国之间没有差异。生殖器感染在肯尼亚和美国南部的性活跃女性中很常见。鉴于 MG 与不良生殖健康结果之间的关联，育龄妇女的 MG 负担可能会导致严重的发病率。
Background Little is known about the natural history of Mycoplasma genitalium (MG) infection in women. We retrospectively tested archived vaginal fluid samples to assess MG prevalence, incidence, persistence, recurrence and antimicrobial resistance markers among women participating in the Preventing Vaginal Infections trial, a randomized trial of monthly presumptive treatment to reduce vaginal infections.Methods High-risk, nonpregnant, HIV-negative women aged 18 to 45 years from Kenya and the United States were randomized to receive metronidazole 750 mg + miconazole 200 mg intravaginal suppositories or placebo for 5 consecutive nights each month for 12 months. Clinician-collected swabs containing cervicovaginal fluid were tested for MG using Hologic nucleic acid amplification testing at enrollment and every other month thereafter. Specimens that were MG+ underwent additional testing for macrolide resistance-mediating mutations by DNA sequencing.Results Of 234 women enrolled, 221 had available specimens and 25 (11.3%) had MG at enrollment. Among 196 women without MG at enrollment, there were 52 incident MG infections (incidence, 33.4 per 100 person-years). Smoking was independently associated with incident MG infection (adjusted hazard ratio, 3.02; 95% confidence interval, 1.32-6.93), and age less than 25 years trended toward an association (adjusted hazard ratio, 1.70; 95% confidence interval, 0.95-3.06). Median time to clearance of incident MG infections was 1.5 months (interquartile range, 1.4-3.0 months). Of the 120 MG+ specimens, 16 specimens from 15 different women were macrolide resistance-mediating mutation positive (13.3%), with no difference by country.ConclusionsM. genitalium infection is common among sexually active women in Kenya and the Southern United States. Given associations between MG and adverse reproductive health outcomes, this high burden of MG in reproductive-aged women could contribute to substantial morbidity.