High prevalence of sexually transmitted infections and risk factors among HIV-positive individuals in Yunnan, China

Background Yunnan has the highest rates of HIV in China. Other treatable sexually transmitted infections (STIs) are associated with accelerated HIV transmission and poor ART outcomes, but are only diagnosed by syndromic algorithms. Methods We recruited 406 HIV-positive participants for a cross-sectional study (204 ART-naive and 202 receiving ART). Blood samples and first-voided urine samples were collected. Real-time polymerase chain reaction methods were used for diagnosing Chlamydia trachomatis (CT), Neisseria gonorrhea (NG) and Mycoplasma genitalium (MG). Syphilis and herpes simplex virus type 2 (HSV-2) tests were also performed. Results Among the 406 participants, the overall prevalence of STIs was 47.0% and 45.1% in ART-naive individuals and 49.0% in individuals receiving ART, respectively. The testing frequencies were 11.6% (11.8% vs. 11.4%), 33.2% (29.4% vs. 37.1%), 3.2% (3.4% vs. 3.0%), 2.0% (3.4% vs. 0.5%) and 4.7% (6.4% vs. 3.0%) for active syphilis, HSV-2, CT, NG and MG, respectively. The percentage of multiple infections in both groups was 10.8% (22/204) in ART-naive participants and 9.9% (20/202) in participants receiving ART. Female sex, an age between 18 and 35 years, ever injecting drugs, homosexual or bisexual status, HIV/HBV coinfection, and not receiving ART were identified as risk factors. Self-reported asymptomatic patients were not eliminated from having a laboratory-diagnosed STI. Conclusions The STI prevalence was 47.0% (45.1% vs. 49.0%), and HSV-2, syphilis and MG were the most common STIs in HIV-infected individuals. We found a high prevalence (6.4%) of MG in ART-naive individuals. HIV-positive individuals tend to neglect or hide their genital tract discomfort; thus, we suggest strengthening STI joint screening and treatment services among HIV-infected individuals regardless of whether they describe genital tract discomfort.

Epidemiological, clinical and laboratory differences between male urethral infections due to Haemophilus spp. and those due to Neisseria gonorrhoeae, Chlamydia trachomatis, Mycoplasma genitalium and Ureaplasma urealyticum: A descriptive study

Objective: To describe the epidemiological, clinical and laboratory characteristics of male patients diagnosed with Haemophilus spp. urethral infection and to compare them with the characteristics of male patients diagnosed with N. gonorrhoeae, C. trachomatis, M. genitalium and U. urealyticum urethral infection. Over the past 2 years, an increase in urethral infections due to Haemophilus spp. was observed. Materials and methods: All male patients who attended our Department of Sexually Transmitted Infections between January 2018 and February 2019 were retrospectively studied; they underwent conventional bacteriological and multiplex PCR studies in the urethra at the same time. Results: Of the 86 patients studied, a unique microorganism was detected in 76 cases, N. gonorrhoeae in 24, Haemophilus spp. in 21 (16 H. parainfluenzae and 5 H. influenzae), C. trachomatis in 19, M. genitalium in 8 and U. urealyticum in 4; 10 cases presented more than one microorganism. In case of multiple aetiological agents, sexual partnership was multiple. In the Haemophilus group, 81% reported only unprotected oral insertive sex; symptoms lasted for more than one week in 62% of the patients. Conclusions: Haemophilus is an aetiological agent of non-gonococcal urethritis whose incidence is clearly increasing; the main route of transmission is oral sex. The most common reason for consultation is dysuria and testicular pain, while urethral discharge was predominant for the other causes of urethral infection. Due to the high frequency of antibiotic resistance in the Haemophilus group, it is necessary to confirm eradication by performing a test of cure.

Mycoplasma genitalium and sexually transmitted infections: evidences and figures in a tertiary hospital

Introduction. Mycoplasma genitalium is an emerging cause of sexually transmitted infections (STIs) and has been implicated in non-gonococcal urethritis in men and cervicitis in woman. The aim of this study is determinate the incidence and pathogenicity of M. genitalium within the diagnosis of STIs detected from clinical samples in a third level hospital. Material and methods. A total of 8,473 samples from endocervix, urethra, vagina, rectum and others were processed applying Allpex STI Essential Assay. More than 190 records were reviewed to determinate M. genitalium pathogenicity. Results. M. genitalium was detected in a rate 2.8%. Co-infections were detected in 20% of the patients. Conclusions. M. genitalium is considered a STI emerging pathogen thanks to the renewal of multiplex-PCR tests although with a low incidence in our approach. Emerging from our experience and the institutional recommendations both detection of acid nucleic techniques (NAATs) and gonococcal culture might be implemented accurately and coexist to adequate prescriptions.

Therapy challenges in patients with Mycoplasma genitalium infection of the urogenital tract: clinical observations

Mycoplasma genitalium is a clinically significant intracellular bacterium from the family of genital mycoplasmas; it absolutely dominates in persistent/recurrent nongonococcal urethritis, causes chronic inflammatory diseases of the urogenital organs which dictates the necessity of treating this infection. The study presents observations of 2 patients with chronic recurrent urethritis caused by multiple drug resistant strains of M. genitalium. None of the administered schemes of antibacterial treatment covered in the international protocols on treatment of M. genitalium infection allowed to achieve clinical or microbiological cure in these patients. Practicing doctors require development and improvement of nucleic acid amplification methods with antimicrobial testing for M. genitalium resistance and new antimicrobial drugs with improved chemical and pharmacological characteristics for treatment of patients with intracellular urogenital infections.

Mycoplasma genitalium Provokes Seminal Inflammation among Infertile Males

The impact of sexually transmitted infections (STI) on male fertility is controversial. Aims: To investigate the prevalence of urethritis-associated STIs (chlamydia, gonorrhoeae, Mycoplasma genitalium, trichomoniasis) among infertile males; to analyze the effect of STIs on semen parameters and blood PSA. Case-control study. Study group (n = 2000): males with fertility problems or desire for fertility check. Control group (n = 248): male partners of pregnant women. Analyses: polymerase chain reaction for STI, seminal interleukin 6 (IL-6), semen and fractionated urine, blood analyses (PSA, reproductive hormones). The prevalence of M. genitalium and chlamydia in the study group was 1.1% and 1.2%, respectively. The prevalence of chlamydia in the control group was 1.6%, while there were no M. genitalium cases. No cases with gonorrhoeae or trichomoniasis or combined infections were observed in neither group. There was a higher seminal concentration of neutrophils and IL-6 among M. genitalium positives compared with STI negatives. There was a trend toward a lower total count of spermatozoa and progressive motility among STI positives. No impact of STIs on PSA was found. The prevalence of STIs among infertile males is low. M. genitalium is associated with seminal inflammation. The impact of STIs on semen parameters deserves further investigations.

Evaluation of treatment with two weeks of doxycycline on macrolide-resistant strains of Mycoplasma genitalium: a retrospective observational study

Background Increasing macrolide resistance makes treatment of Mycoplasma genitalium infections challenging. The second-line treatment is moxifloxacin, an antibiotic drug best avoided due to the potential of severe side effects and interactions. This study evaluates the effects of treatment with doxycycline 100 mg twice daily for 2 weeks as an alternative to moxifloxacin. Methods This retrospective observational study examined the medical records of patients testing positive for macrolide resistant Mycoplasma genitalium from January 1st, 2016 to September 1st, 2019 in Trondheim, Norway. Information regarding symptoms as well as clinical and microbiological cure was collected. Results 263 infections from 259 patients (161 females/98 males) were examined. 155 (58.9%) had a negative test of cure following treatment. 34.7% of symptomatic patients not achieving microbiological cure experienced symptom relief or clearance. There was no statistical difference between bacterial loads in symptomatic versus asymptomatic patients. The mean difference was 1.6 × 105 copies/ml (95% CI − 1.4 × 105–4.8 × 105, p = 0.30) for women and 1.4 × 106 copies/ml (95% CI -4.0 × 105–3.2 × 106, p = 0.12) for men. Conclusions The cure rate of doxycycline in this study is higher than previously reported. This adds support to doxycycline’s role in treatment before initiating treatment with less favorable drugs such as moxifloxacin.

Practical approaches to examination of women with abnormal vaginal discharge: a review of evidence-based recommendations 2021

Abnormal vaginal discharge (AVD) is a syndrome that combines conditions of different origin (microbial/non-microbial) and of different anatomical localization (limited to vagina and exocervix/spreading from the endocervix to the pelvic organs) that cause discomfort and changes in the characteristics of vaginal discharge.Review objective: to systematize modern approaches to the diagnosis of the most common causes of AVD – bacterial vaginosis (BV), trichomoniasis, aerobic vaginitis (AV), vulvovaginal candidiasis (VVC) – in a practical context. Laboratory component of diagnosing the AVD causes should be complex due to the not fully understood mechanisms of regulation of vaginal biocenosis and changes in the virulence of opportunistic and pathogenic flora, leading to an increase in the frequency of mixed forms of vaginosis and their atypical course. The tasks of laboratory tests in AVD are determination of the sexually transmitted infections (gonorrhea, chlamydia, Mycoplasma genitalium) more often as a concomitant asymptomatic infection in combination with BV or another cause of AVD; confirmation of the suspected cause of AVD (BV, trichomoniasis, AV, VVC); differential diagnosis with more rare microbial causes (cytolytic vaginosis) and non-microbial causes.Vaginal pH and microscopy of vaginal discharge with an assessment according to the diagnostic criteria for dysbiosis are first line of available diagnostic tests of BV, AV and VVC. They make it possible to differentiate typical AVD causes from non-microbial AVD causes and rare causes of microbial AVD. Additionally, complex modern molecular methods for assessing the vaginal biocenosis can be used. Cultural methods play an important role in the diagnosis and treatment of recurrent/complicated VVC and AV. PCR for chlamydia, gonorrhea, trichomoniasis and Mycoplasma genitalium is a mandatory component of a comprehensive test in patients with suspected BV, AV or mixed dysbiosis. Patients diagnosed with BV or trichomoniasis has to be tested for HIV and sexually transmitted infections.

Evaluation of urethrotropic clade meningococcal infection by urine metagenomic shotgun sequencing.

Background Urethral infections caused by an emerging nongroupable (NG) urethrotropic clade of Neisseria meningitidis (Nm) were first reported in the United States in 2015 (the “U.S. NmNG urethritis clade”). Here we evaluate for the presence of other urethral pathogens in men with U.S. NmNG urethritis clade infection. Methods: We evaluated 129 urine specimens collected from men at a sexual health clinic, including 33 from patients with culture-confirmed or suspected urethral Nm infection and 96 specimens in which nucleic acid amplification test detected Neisseria gonorrhoeae (Ng), Chlamydia trachomatis (Ct), both pathogens, or neither pathogen. Nm was detected first by real-time PCR, followed by metagenomic shotgun sequencing of 91 specimens to identify coinfections. Nm genomes were sequenced following selective whole genome amplification when possible. Results: Metagenomic sequencing detected Nm in 16 of 17 specimens from culture-confirmed Nm cases, with no coinfection by other conventional urethral pathogens. Metagenomic sequencing also detected Nm in three Ct positive specimens, one specimen positive for both Ng and Ct, and nine specimens with negative Ng and Ct results, eight of which had suspected Neisseria infections. Nm from culture-confirmed Nm cases belonged to the U.S. NmNG urethritis clade, while Nm identified in other specimens belonged to multiple clonal complexes. Additional urethral pathogens were predominant in non-Nm specimens, including Ng, Ct, Mycoplasma genitalium , Ureaplasma urealyticum , and herpes simplex virus type-2. Conclusions: Coinfection with other conventional urethral pathogens is rare in men with culture-confirmed U.S. NmNG urethritis clade infection and points to the strong association of this clade with disease.