MRC Centre for Outbreak Analysis & Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, Norfolk Place, London, W2 1PG, UK.
Earth Institute & Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, USA.
Sci Rep. 2017 Nov 23;7(1):16162. doi: 10.1038/s41598-017-16302-8.
There is increasing concern about Mycoplasma genitalium as a cause of urethritis, cervicitis, pelvic inflammatory disease (PID), infertility and ectopic pregnancy. Commercial nucleic acid amplification tests (NAATs) are becoming available, and their use in screening for M. genitalium has been advocated, but M. genitalium's natural history is poorly-understood, making screening's effectiveness unclear. We used a transmission-dynamic compartmental model to synthesise evidence from surveillance data and epidemiological and behavioural studies to better understand M. genitalium's natural history, and then examined the effects of implementing NAAT testing. Introducing NAAT testing initially increases diagnoses, by finding a larger proportion of infections; subsequently the diagnosis rate falls, due to reduced incidence. Testing only symptomatic patients finds relatively little infection in women, as a large proportion is asymptomatic. Testing both symptomatic and asymptomatic patients has a much larger impact and reduces cumulative PID incidence in women due to M. genitalium by 31.1% (95% range:13.0%-52.0%) over 20 years. However, there is important uncertainty in M. genitalium's natural history parameters, leading to uncertainty in the absolute reduction in PID and sequelae. Empirical work is required to improve understanding of key aspects of M. genitalium's natural history before it will be possible to determine the effectiveness of screening.
人们越来越关注生殖支原体作为尿道炎、宫颈炎、盆腔炎 (PID)、不孕和宫外孕的病因。商业性核酸扩增检测 (NAAT) 正在普及，提倡将其用于筛查生殖支原体，但生殖支原体的自然史知之甚少，因此筛查的效果尚不清楚。我们使用传播动力学房室模型，综合监测数据以及流行病学和行为研究的证据，以更好地了解生殖支原体的自然史，然后检查实施 NAAT 检测的效果。最初，通过发现更大比例的感染，NAAT 检测会增加诊断数量；随后，由于发病率降低，诊断率下降。仅对有症状的患者进行检测，在女性中发现的感染相对较少，因为很大一部分是无症状的。同时对有症状和无症状的患者进行检测，影响更大，在 20 年内将女性因生殖支原体引起的 PID 累积发病率降低 31.1%（95%范围：13.0%-52.0%）。然而，生殖支原体自然史参数存在重要的不确定性，导致 PID 和后遗症的绝对减少存在不确定性。在确定筛查的有效性之前，需要进行实证工作来提高对生殖支原体自然史关键方面的理解。
