scholarly journals The vaginal microbiota and its association with human papillomavirus, Chlamydia trachomatis, Neisseria gonorrhoeae and Mycoplasma genitalium infections: a systematic review and meta-analysis

2019 ◽  
Vol 25 (1) ◽  
pp. 35-47 ◽  
Author(s):  
J. Tamarelle ◽  
A.C.M. Thiébaut ◽  
B. de Barbeyrac ◽  
C. Bébéar ◽  
J. Ravel ◽  
...  
Keyword(s):  
Systematic Review ◽  
Human Papillomavirus ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Meta Analysis ◽  
Mycoplasma Genitalium ◽  
Vaginal Microbiota

scholarly journals Mycoplasma genitaliumincidence, persistence, concordance between partners and progression: systematic review and meta-analysis

2018 ◽  
Author(s):  
Manuel Cina ◽  
Lukas Baumann ◽  
Dianne Egli-Gany ◽  
Florian S Halbeisen ◽  
Hammad Ali ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chlamydia Trachomatis ◽  
Natural History ◽  
Pelvic Inflammatory Disease ◽  
Inflammatory Disease ◽  
Meta Analysis ◽  
Mycoplasma Genitalium ◽  
Developed Countries ◽  
Sexual Partners ◽  
Sexually Transmitted

ABSTRACTBackgroundMycoplasma genitaliumis increasingly seen as an emerging sexually transmitted pathogen, and has been likened toChlamydia trachomatis, but its natural history is poorly understood. The objectives of this systematic review were to determineM. genitaliumincidence, persistence, concordance between sexual partners, and the risk of pelvic inflammatory disease (PID).MethodsWe searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.ResultsWe screened 4634 records and included 17 studies; five (4100 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI, 0.61 to 1.53, I2 0%). Median persistence ofM. genitaliumwas estimated from one to three months in four studies but 15 months in one study. In ten studies measuringM. genitaliuminfection status in couples, 39-50% of male or female sexual partners of infected participants also hadM. genitaliumdetected. In prospective studies, the incidence of PID was higher in women withM. genitaliumthan those without (RR 1.68, 95% CI 0.59 to 2.77, I20%, 2 studies).DiscussionBased on findings from this and our linked review of prevalence, concordantM. genitaliummight be less common than forC. trachomatisand the age distributions of the infections differ. The synthesised data about prevalence, incidence and persistence ofM. genitaliuminfection are inconsistent. Taken together with evidence about antimicrobial resistance in the two infections,M. genitaliumis not the new chlamydia.Registration NumbersPROSPERO: CRD42015020420, CRD42015020405KEY MESSAGESThere are calls for widespread screening forMycoplasma genitalium, but the natural history of this emerging sexually transmitted pathogen is poorly understood.M. genitaliumincidence was 1.07 (95% confidence intervals, CI 0.61 to 1.53) per 100-person years in women in highly developed countries, 39-50% of infected individuals had a heterosexual partner withM. genitaliumand the risk ratio for pelvic inflammatory disease was 1.68 (95% CI 0.59 to 2.77).The duration of untreatedM. genitaliuminfection is probably longer than persistent detection ofM. genitalium, as measured in most cohort studies, in which inadvertent treatment cannot be ruled out.The results of this systematic review and other evidence sources show important differences in the epidemiology and dynamics ofM. genitaliumandChlamydia trachomatisinfection.

scholarly journals Factors associated with anorectal Chlamydia trachomatis or Neisseria gonorrhoeae test positivity in women: a systematic review and meta-analysis

2019 ◽  
Vol 95 (5) ◽  
pp. 361-367 ◽  
Author(s):  
Andrew Lau ◽  
Fabian Yuh Shiong Kong ◽  
Willa Huston ◽  
Eric P F Chow ◽  
Christopher K Fairley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
English Language ◽  
Meta Analysis ◽  
Prevalence Ratio ◽  
Anal Intercourse ◽  
Summary Estimate ◽  
Language Studies ◽  
Meta Analyses

ObjectivesThere has been considerable discussion about anorectal Chlamydia trachomatis (CT) in women, with some calling for anorectal CT screening, but little about anorectal Neisseria gonorrhoeae (NG). Given that urogenital NG is more strongly associated with pelvic inflammatory disease, this is an evidence gap. This systematic review and meta-analysis investigates the associations between anorectal CT in women and CT positivity at other sites (urogenital/oropharyngeal) and with anal intercourse, and compares these with anorectal NG within the same study populations.MethodsElectronic databases were searched for English-language studies published to October 2018 using the following terms: (“Chlamydia” OR “Chlamydia trachomatis”) AND ((“anal” OR “rect*” OR “anorect*”) OR (“extra?genital” OR “multi?site”)). Studies were included if anorectal NG data were available. Random-effects meta-analyses calculated pooled estimates; heterogeneity was investigated using meta-regression.Results25 studies were eligible. Anorectal CT positivity ranged from 0% to 17.5%, with a summary estimate of 8.0% (95% CI 7.0 to 9.1; I2=88.5%). Anorectal NG positivity ranged from 0% to 17.0%, with a summary estimate of 2.1% (95% CI 1.6 to 2.8; I2=92.7%). The association between urogenital and anorectal positivity was stronger for NG than CT (summary prevalence ratio (PR)=89.3 (95% CI 53.1 to 150.3; I2=80.1%), PR=32.2 (95% CI 25.6 to 40.7; I2=70.3%), respectively), and between oropharyngeal and anorectal positivity it was stronger for NG than CT (PR=34.8 (95% CI 10.2 to 118.2; I2=89.9%), PR=8.8 (95% CI 6.8 to 11.5; I2=58.1%), respectively). Anal intercourse was associated with anorectal NG (PR=4.3; 95% CI 2.2 to 8.6; I2=0.0%) but not with anorectal CT (PR=1.0; 95% CI 0.7 to 1.4; I2=0.0%).ConclusionsAnorectal CT is more common than anorectal NG, but anorectal NG is more strongly associated with anal intercourse, urogenital and oropharyngeal NG, suggesting that ongoing discussion about anorectal CT should also include NG. Longitudinal data are required to further understanding of the aetiology of anorectal STIs and assess whether anorectal screening is needed in women.Trial registration numberCRD42df017080188.

scholarly journals Adverse pregnancy and neonatal outcomes associated with Neisseria gonorrhoeae, Mycoplasma genitalium, M. hominis, Ureaplasma urealyticum and U. parvum: a systematic review and meta-analysis protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e024175 ◽  
Author(s):  
Lisa M Vallely ◽  
Dianne Egli-Gany ◽  
William Pomat ◽  
Caroline SE Homer ◽  
Rebecca Guy ◽  
...  
Keyword(s):  
Systematic Review ◽  
Preterm Birth ◽  
Neisseria Gonorrhoeae ◽  
Ureaplasma Urealyticum ◽  
Meta Analysis ◽  
Perinatal Outcomes ◽  
Mycoplasma Genitalium ◽  
Sexually Transmitted ◽  
Adverse Pregnancy ◽  
In Pregnancy

IntroductionSeveral bacterial sexually transmitted and genital mycoplasma infections during pregnancy have been associated with poor pregnancy and perinatal outcomes. Comprehensive and systematic information about associations between sexually transmitted infections (STI) and genital infections in pregnancy and adverse perinatal outcomes is needed to improve understanding about the evidence for causal associations between these infections and adverse pregnancy and neonatal outcomes. Our primary objective is to systematically review the literature about associations between: (1) Neisseria gonorrhoeae in pregnancy and preterm birth; (2) Mycoplasma genitalium in pregnancy and preterm birth; (3) M. hominis, Ureaplasma urealyticum and/or U. parvum in pregnancy and preterm birth.Methods and analysisWe will undertake a systematic search of Medline, Excerpta Medica database and the Cochrane Library and Cumulative Index to Nursing and Allied Health Literature. Following an initial screening of titles by one reviewer, abstracts will be independently assessed by two reviewers before screening of full-text articles. To exclude a manuscript, both reviewers need to agree on the decision. Any discrepancies will be resolved by discussion, or the adjudication of a third reviewer. Studies will be included if they report testing for one or more of N. gonorrhoeae, M. genitalium, M. hominis, U. urealyticum and/or U. parvum during pregnancy and report pregnancy and/or birth outcomes. In this review, the primary outcome is preterm birth. Secondary outcomes are premature rupture of membranes, low birth weight, spontaneous abortion, stillbirth, neonatal mortality and ophthalmia neonatorum. We will use standard definitions, or definitions reported by study authors. We will examine associations between exposure and outcome in forest plots, using the I2 statistic to examine between study heterogeneity. Where appropriate, we will use meta-analysis to combine results of individual studies.Ethics and disseminationThis systematic review of published literature does not require ethical committee approval. Results of this review will be published in a peer reviewed, open access journal.PROSPERO registration numberCRD42016050962.

scholarly journals Diagnostic accuracy of pooling urine, anorectal, and oropharyngeal specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae: a systematic review and meta-analysis

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Lily Aboud ◽  
Yangqi Xu ◽  
Eric P. F. Chow ◽  
Teodora Wi ◽  
Rachel Baggaley ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Diagnostic Accuracy ◽  
Meta Analysis ◽  
Cost Savings ◽  
Molecular Diagnostic ◽  
Anatomic Site ◽  
Significant Cost ◽  
Pooled Testing

Abstract Background Screening for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) at genital and extragenital sites is needed for most key populations, but molecular diagnostic tests for CT/NG are costly. We aimed to determine the accuracy of pooled samples from multiple anatomic sites from one individual to detect CT/NG using the testing of a single sample from one anatomic site as the reference. Methods In this systematic review and meta-analysis, we searched five databases for articles published from January 1, 2000, to February 4, 2021. Studies were included if they contained original data describing the diagnostic accuracy of pooled testing compared with single samples, resource use, benefits and harms of pooling, acceptability, and impact on health equity. We present the pooled sensitivities and specificities for CT and NG using a bivariate mixed-effects logistic regression model. The study protocol is registered in PROSPERO, an international database of prospectively registered systematic reviews (CRD42021240793). We used GRADE to evaluate the quality of evidence. Results Our search yielded 7814 studies, with 17 eligible studies included in our review. Most studies were conducted in high-income countries (82.6%, 14/17) and focused on men who have sex with men (70.6%, 12/17). Fourteen studies provided 15 estimates for the meta-analysis for CT with data from 5891 individuals. The pooled sensitivity for multisite pooling for CT was 93.1% [95% confidence intervals (CI) 90.5–95.0], I2=43.3, and pooled specificity was 99.4% [99.0–99.6], I2=52.9. Thirteen studies provided 14 estimates for the meta-analysis for NG with data from 6565 individuals. The pooled sensitivity for multisite pooling for NG was 94.1% [95% CI 90.9–96.3], I2=68.4, and pooled specificity was 99.6% [99.1–99.8], I2=83.6. Studies report significant cost savings (by two thirds to a third). Conclusion Multisite pooled testing is a promising approach to improve testing coverage for CT/NG in resource-constrained settings with a small compromise in sensitivity but with a potential for significant cost savings.

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