Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics

Lusk, M Josephine; Garden, Frances L.; Rawlinson, William D.; Naing, Zin; Cumming, Robert G.; Konecny, Pam

doi:10.1136/sextrans-2015-052332

Cited by 34 publications

(31 citation statements)

References 28 publications

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“…In women, there is no adequate evidence that M. hominis, U. parvum or U. urealyticum causes an inflammatory vulvovaginitis, cervicitis, urethritis, PID or infertility. 4,[48][49][50][51][67][68][69]71,72,76,77 In many studies, appropriate species differentiation of U. urealyticum and U. parvum has not been performed and/ or important confounding factors such as recognized STIs and especially BV have not been addressed, making disease associations with the urogenital mycoplasmas mostly undocumented.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the unadjusted prevalence ratios of cervicitis have been reported as 1.00 #bib1.09 and 0.96 for M. hominis , U. parvum or U. urealyticum , respectively . Also in additional cervicitis studies, none of these three urogenital mycoplasmas was associated with cervicitis and the bacterial load of neither U. parvum nor U. urealyticum has been associated with symptoms or signs of genital infection . Nevertheless, in one molecular study of non‐gonococcal non‐chlamydial cervicitis, despite no difference in U. parvum and U. urealyticum presence in women with cervicitis and controls, the bacterial load of U. parvum and U. urealyticum was significantly higher in women with cervicitis compared to controls …”

Section: Womenmentioning

confidence: 99%

See 1 more Smart Citation

Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? – a position statement from the European STI Guidelines Editorial Board

Horner

Donders

Cusini

et al. 2018

Acad Dermatol Venereol

169

146

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At present, we have no evidence that we are doing more good than harm detecting and subsequently treating Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum colonizations/infections. Consequently, routine testing and treatment of asymptomatic or symptomatic men and women for M. hominis, U. urealyticum and U. parvum are not recommended. Asymptomatic carriage of these bacteria is common, and the majority of individuals do not develop any disease. Although U. urealyticum has been associated with urethritis in men, it is probably not causal unless a high load is present (likely carriage in 40-80% of detected cases). The extensive testing, detection and subsequent antimicrobial treatment of these bacteria performed in some settings may result in the selection of antimicrobial resistance, in these bacteria, 'true' STI agents, as well as in the general microbiota, and substantial economic cost for society and individuals, particularly women. The commercialization of many particularly multiplex PCR assays detecting traditional non-viral STIs together with M. hominis, U. parvum and/or U. urealyticum has worsened this situation. Thus, routine screening of asymptomatic men and women or routine testing of symptomatic individuals for M. hominis, U. urealyticum and U. parvum is not recommended. If testing of men with symptomatic urethritis is undertaken, traditional STI urethritis agents such as Neisseria gonorrhoeae, Chlamydia trachomatis, M. genitalium and, in settings where relevant, Trichomonas vaginalis should be excluded prior to U. urealyticum testing and quantitative species-specific molecular diagnostic tests should be used. Only men with high U. urealyticum load should be considered for treatment; however, appropriate evidence for effective treatment regimens is lacking. In symptomatic women, bacterial vaginosis (BV) should always be tested for and treated if detected.

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Section: Discussionmentioning

confidence: 99%

Section: Womenmentioning

confidence: 99%

Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? – a position statement from the European STI Guidelines Editorial Board

Horner

Donders

Cusini

et al. 2018

Acad Dermatol Venereol

169

146

View full text Add to dashboard Cite

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“…Earlier studies in other settings suggest, however, that the inclusion of BV appears to have little impact on the performance of syndromic management among antenatal women 15 23 or among women attending sexual health or family planning clinics. 22 24 25 MG has been associated with vaginal discharge among women in a variety of settings, 24 26 but its presence and clinical correlates have not been investigated among women in PNG. It is therefore difficult to estimate the impact of undiagnosed MG on the performance of syndromic management in the current study.…”

Section: Discussionmentioning

confidence: 99%

Performance of syndromic management for the detection and treatment of genitalChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginalisamong women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study

et al. 2017

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ObjectivePapua New Guinea (PNG) has among the highest estimated prevalences of genital Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and Trichomonas vaginalis (TV) of any country in the Asia-Pacific region. Diagnosis and treatment of these infections have relied on the WHO-endorsed syndromic management strategy that uses clinical presentation without laboratory confirmation to make treatment decisions. We evaluated the performance of this strategy in clinical settings in PNG.DesignWomen attending antenatal (ANC), well woman (WWC) and sexual health (SHC) clinics in four provinces were invited to participate, completed a face-to-face interview and clinical examination, and provided genital specimens for laboratory testing. We estimated the performance characteristics of syndromic diagnoses against combined laboratory diagnoses.Results1764 women were enrolled (ANC=765; WWC=614; SHC=385). The prevalences of CT, NG and TV were highest among women attending ANC and SHC. Among antenatal women, syndromic diagnosis of sexually transmitted infection had low sensitivity (9%–21%) and positive predictive value (PPV) (7%–37%), but high specificity (76%–89%) and moderate negative predictive value (NPV) (55%–86%) for the combined endpoint of laboratory-confirmed CT, NG or TV. Among women attending WWC and SHC, ‘vaginal discharge syndrome’ had moderate to high sensitivity (72%–78%) and NPV (62%–94%), but low specificity (26%–33%) and PPV (8%–38%). ‘Lower abdominal pain syndrome’ had low sensitivity (26%–41%) and PPV (8%–23%) but moderate specificity (66%–68%) and high NPV (74%–93%) among women attending WWC, and moderate-high sensitivity (67%–79%) and NPV (62%–86%) but low specificity (26%–28%) and PPV (14%–33%) among SHC attendees.ConclusionThe performance of syndromic management for the detection and treatment of genital chlamydia, gonorrhoea and trichomonas was poor among women in different clinical settings in PNG. New diagnostic strategies are needed to control these infections and to prevent their adverse health outcomes in PNG and other high-burden countries.

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“…The cervical Gram stain smear has not been standardized and is regarded by the CDC as unhelpful in diagnosis of cervicitis [ 3 ]. However, in a study of 558 women in Sydney, the case definition of cervicitis with microscopy (>30 PMNLs) plus cervical discharge had the highest prevalence ratio, positive predictive value, and specificities but lowest sensitivities for the significant pathogens Ct, Ng, Mg, and Tv [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection

Randjelovic

Moghaddam

Blasio

et al. 2018

Infectious Diseases in Obstetrics and Gynecology

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Objective The aim of this study was to evaluate whether the polymorphonuclear leukocyte (PMNL) inflammatory response in women with nongonococcal lower genital tract infection (LGTI) can be used to optimize criteria for syndromic treatment. Methods A cross-sectional study of 375 women attending the STI clinic in Oslo. Urethral, cervical, and vaginal specimens underwent microscopy for PMNLs. Chlamydia trachomatis (Ct) and other STIs were detected in the cervical/vaginal swabs and urine, using nucleic acid amplification test (NAAT). After excluding vulvovaginal candidiasis, genital herpes, and trichomoniasis, we correlated clinical and microscopic signs of inflammation with positive NAAT for Ct, mycoplasma genitalium (Mg), and Ureaplasma urealyticum (Uu) in a subgroup of 293 women. Results To predict a positive Ct, the combination of high cut-off urethritis (≥10 PMNLs/HPF) and microscopic cervicitis had a high specificity of 0.93, a PPV of 0.37, and a sensitivity of 0.35. LGTI criteria had low predicting values for Mg and Uu. Conclusion Including microscopic criteria for the diagnosis of LGTI gives better indication for presumptive antibiotic treatment than anamnestic and clinical diagnosis alone.

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Cervicitis aetiology and case definition: a study in Australian women attending sexually transmitted infection clinics

Cited by 34 publications

References 28 publications

Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? – a position statement from the European STI Guidelines Editorial Board

Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and Ureaplasma urealyticum in men and women? – a position statement from the European STI Guidelines Editorial Board

Performance of syndromic management for the detection and treatment of genitalChlamydia trachomatis,Neisseria gonorrhoeaeandTrichomonas vaginalisamong women attending antenatal, well woman and sexual health clinics in Papua New Guinea: a cross-sectional study

The Role of Polymorphonuclear Leukocyte Counts from Urethra, Cervix, and Vaginal Wet Mount in Diagnosis of Nongonococcal Lower Genital Tract Infection

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