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Should we be testing for urogenital Mycoplasma hominis, Ureaplasma parvum and U. urealyticum in men and women?: a Position Statement from the European STI Guidelines Editorial Board
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, United Kingdom.
Department of Obstetrics and Gynecology, University Hospital Antwerp, Edegem, Belgium.
Department of Dermatology, Fondazione IRCCS Ca' Granda Ospedale Policlinico, Milano, Italy.
Moscow Scientific and Practical Center of Dermatovenereology and Cosmetology, Moscow, Russia.
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2018 (English)In: Journal of the European Academy of Dermatology and Venereology, ISSN 0926-9959, E-ISSN 1468-3083, Vol. 32, no 11, p. 1845-1851Article in journal (Refereed) Published
Abstract [en]

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 colonisations/infections. Consequently, routine testing and treatment of asymptomatic or symptomatic men and women for M. hominis, U. urealyticum, and U. parvum is not recommended. Asymptomatic carriage of these bacteria is common and the majority of individuals do not develop 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 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 commercialisation of many particularly multiplex PCR assays detecting traditional non-viral STIs together with M. hominis, U. parvum and/or U. urealyticum have 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.

Place, publisher, year, edition, pages
Blackwell Publishing, 2018. Vol. 32, no 11, p. 1845-1851
Keywords [en]
Mycoplasma hominis, Ureaplasma parvum, Ureaplasma urealyticum, cervicitis, sexually transmitted infection (STI), urethritis
National Category
Infectious Medicine Dermatology and Venereal Diseases
Identifiers
URN: urn:nbn:se:oru:diva-67513DOI: 10.1111/jdv.15146ISI: 000448786400026PubMedID: 29924422Scopus ID: 2-s2.0-85050492713OAI: oai:DiVA.org:oru-67513DiVA, id: diva2:1224023
Note

Funding Agencies:

NIHR Health Protection Research Unit in Evaluation of Interventions at University of Bristol  

Public Health England (PHE)  

Foundation for Medical Research at Örebro University Hospital, Örebro, Sweden  

WHO  

ECDC  

Örebro County Council Research Committee, Örebro, Sweden 

Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2018-11-19Bibliographically approved

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