Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
National Institute for Health Research Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
J Eur Acad Dermatol Venereol. 2018 Nov;32(11):1845-1851. doi: 10.1111/jdv.15146. Epub 2018 Jul 6.
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.
目前，我们没有证据表明检测和随后治疗人型支原体、解脲脲原体和微小脲原体定植/感染能带来更多好处而非危害。因此，不建议对无症状或有症状的男性和女性常规检测和治疗人型支原体、解脲脲原体和微小脲原体。这些细菌无症状携带很常见，大多数人不会出现任何疾病。虽然解脲脲原体与男性尿道炎有关，但除非负荷很高（在检测到的病例中，可能有 40-80%的人携带），否则它可能不是致病原因。在某些情况下，对这些细菌进行广泛的检测、发现和随后的抗菌治疗可能会导致细菌耐药性的选择，包括真正的性传播感染病原体，以及一般微生物群，这会给社会和个人带来巨大的经济成本，尤其是女性。许多检测传统非病毒性性传播感染病原体的多重 PCR 检测试剂盒的商业化，加上人型支原体、解脲脲原体和/或微小脲原体的商业化，使情况更加恶化。因此，不建议对无症状男性和女性进行常规筛查，也不建议对有症状的个体进行常规检测以检测人型支原体、解脲脲原体和微小脲原体。如果对有症状尿道炎的男性进行检测，在进行解脲脲原体检测之前，应排除淋病奈瑟菌、沙眼衣原体、生殖支原体等传统性传播感染尿道炎病原体，并且应使用定量种特异性分子诊断检测。只有高解脲脲原体负荷的男性才应考虑进行治疗；然而，缺乏有效治疗方案的适当证据。在有症状的女性中，应始终检测并治疗细菌性阴道病（BV）。
