Moi Harald, Reinton Nils, Randjelovic Ivana, Reponen Elina J, Syvertsen Line, Moghaddam Amir
1 The Olafia Clinic, Faculty of Medicine, Oslo University Hospital, Oslo, Norway.
2 Fürst Medisinsk Laboratorium, Oslo, Norway.
Int J STD AIDS. 2017 Jul;28(8):773-780. doi: 10.1177/0956462416666482. Epub 2016 Aug 24.
A non-syndromic approach to treatment of people with non-gonococcal urethritis (NGU) requires identification of pathogens and understanding of the role of those pathogens in causing disease. The most commonly detected and isolated micro-organisms in the male urethral tract are bacteria belonging to the family of Mycoplasmataceae, in particular Ureaplasma urealyticum and Ureaplasma parvum. To better understand the role of these Ureaplasma species in NGU, we have performed a prospective analysis of male patients voluntarily attending a drop in STI clinic in Oslo. Of 362 male patients who were tested for NGU using microscopy of urethral smears, we found the following sexually transmissible micro-organisms: 16% Chlamydia trachomatis, 5% Mycoplasma genitalium, 14% U. urealyticum, 14% U. parvum and 5% Mycoplasma hominis. We found a high concordance in detecting in turn U. urealyticum and U. parvum using 16s rRNA gene and ureD gene as targets for nucleic acid amplification testing (NAAT). Whilst there was a strong association between microscopic signs of NGU and C. trachomatis infection, association of M. genitalium and U. urealyticum infections in turn were found only in patients with severe NGU (>30 polymorphonuclear leucocytes, PMNL/high powered fields, HPF). U. parvum was found to colonise a high percentage of patients with no or mild signs of NGU (0-9 PMNL/HPF). We conclude that urethral inflammatory response to ureaplasmas is less severe than to C. trachomatis and M. genitalium in most patients and that testing and treatment of ureaplasma-positive patients should only be considered when other STIs have been ruled out.
一种针对非淋菌性尿道炎（NGU）患者的非综合征性治疗方法需要识别病原体，并了解这些病原体在致病过程中的作用。男性尿道中最常检测和分离出的微生物是属于支原体科的细菌，尤其是解脲脲原体和微小脲原体。为了更好地理解这些脲原体在NGU中的作用，我们对自愿前往奥斯陆一家性传播感染门诊的男性患者进行了前瞻性分析。在362名接受尿道涂片显微镜检查以诊断NGU的男性患者中，我们发现了以下性传播微生物：沙眼衣原体占16%，生殖支原体占5%，解脲脲原体占14%，微小脲原体占14%，人型支原体占5%。我们发现，以16s rRNA基因和ureD基因作为核酸扩增检测（NAAT）的靶点，依次检测解脲脲原体和微小脲原体时，一致性很高。虽然NGU的显微镜下体征与沙眼衣原体感染之间存在强烈关联，但生殖支原体和解脲脲原体感染之间的关联仅在严重NGU患者（>30个多形核白细胞，PMNL/高倍视野，HPF）中发现。微小脲原体在无NGU体征或轻度体征（0 - 9个PMNL/HPF）的患者中定植比例很高。我们得出结论，在大多数患者中，尿道对脲原体的炎症反应比对沙眼衣原体和生殖支原体的炎症反应轻，并且只有在排除其他性传播感染后，才应考虑对脲原体阳性患者进行检测和治疗。
