Mycoplasma Genitalium and Pelvic Inflammatory Disease

描述（由申请人提供）：盆腔炎（PID）是一种常见于年轻女性的疾病，可导致严重的后遗症，包括不孕、复发和慢性盆腔疼痛。虽然淋病奈瑟菌和/或沙眼衣原体从大约三分之一至一半的PID妇女中回收，但在其他妇女中，病原体通常无法识别。几项研究表明生殖支原体与男性耐药尿道炎有关，但M。生殖器在PID及其后遗症的研究很少。绝大多数疑似PID的美国妇女接受针对淋病和衣原体PID的抗生素治疗。然而，M.生殖器属于一类称为支原体的细菌，由于缺乏细胞壁而与其他细菌不同。因此，它可能对细胞壁抑制头孢菌素类（包括头孢西丁）具有耐药性。此外，其他支原体已显示出对四环素类相当大的耐药性。我们建议，妇女与M。用目前PID方案治疗的生殖器上生殖道感染可能会出现持续感染和生殖系统发病率。 我们提出了一个M。生殖器聚合酶链反应（PCR）研究的831名妇女正在进行的PID评估和临床健康研究。使用储存的基线和30天宫颈和子宫内膜标本，我们建议：1）确定M的危险因素;生殖器感染的下，上生殖道; 2）确定之间的关联M。描述了上、下生殖道M的临床特点。生殖器感染; 4）评估M.生殖器对头孢西丁和多西环素的影响; 5）评价M.生殖道感染对生殖系统发病率的影响。 探索M的作用。在PID中的生殖器必须优化诊断和治疗，并预防非淋菌/非衣原体PID妇女的生殖器发病率。

DESCRIPTION (provided by applicant): Pelvic Inflammatory Disease (PID) is a common disease among young women that results in serious sequelae including infertility, recurrence, and chronic pelvic pain. Although Neisseria gonorrhoeae and/or Chlamydia trachomatis are recovered from approximately a third to a half of women with PID, in the other women the etiologic agent is often unidentified. Several studies have linked Mycoplasma genitalium with drug-resistant urethritis in men, but the role of M. genitalium in PID and its sequelae has been little studied. The great majority of American women with suspected PID are treated with antibiotic regimens directed toward gonorrhea and chlamydial PID. However, M. genitalium belongs to a class of bacteria called mycoplasmas, differentiated from other bacteria by lack of a cell wall. Therefore, it is likely resistant to cell wall inhibiting cephalosporins, including cefoxitin. Additionally, other mycoplasmas have demonstrated considerable resistance to tetracyclines. We propose that women with M. genitalium upper genital tract infection treated with current PID regimens may experience persistent infection and reproductive morbidity. We propose an M. genitalium polymerase chain reaction (PCR) study of 831 women in the ongoing PID Evaluation and Clinical Health Study. Using stored baseline and 30 day cervical and endometrial specimens, we propose to: 1) identify the risk factors for M. genitalium infection of the lower and upper genital tract; 2) determine the associations between M. genitalium, endometritis, and cervicitis; 3) describe the clinical features of women with upper and lower genital tract M. genitalium infection; 4) assess the treatment response of M. genitalium to cefoxitin and doxycycline; and 5) evaluate the impact of M. genitalium infection on reproductive morbidity. Exploring the role of M. genitalium in PID is imperative to optimize diagnosis and treatment and prevent reproductive morbidity among women with nongonococcal/nonchlamydial PID.