Central Clinical School, Monash University, Melbourne, Australia.
Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
Clin Infect Dis. 2021 Aug 16;73(4):659-668. doi: 10.1093/cid/ciab061.
There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum with symptoms or disease in nonpregnant women. However, testing and reporting of these organisms frequently occurs, in part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum, and U. parvum were associated with symptoms and/or signs in nonpregnant women attending a sexual health service.
Eligible women attending the Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum, and U. parvum, and 4 nonviral STIs using a commercial multiplex-PCR.
1272 women were analyzed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR = 2.70, 95%CI:1.92-3.79), vaginal malodor (aOR = 4.27, 95%CI:3.08-5.91), vaginal pH > 4.5 (aOR = 4.27, 95%CI:3.22-5.66), and presence of clue cells (aOR = 8.08, 95%CI:5.68-11.48). Ureaplasma spp. were not associated with symptoms/signs. Bacterial vaginosis was strongly associated with M. hominis (aOR = 8.01, 95%CI:5.99-10.71), but was not associated with either Ureaplasma spp. In stratified analyses, M. hominis was associated with self-reported vaginal malodor and clinician-recorded vaginal discharge in women with BV, but not with symptoms/signs in women without BV.
Only M. hominis was associated with symptoms/signs, and these were manifestations of BV. Importantly, M. hominis was not associated with symptoms/signs in women without BV. These findings do not support routine testing for M. hominis, U. urealyticum, and U. parvum in nonpregnant women.
有限的证据表明，解脲支原体、人型支原体和微小脲原体与非孕妇的症状或疾病之间存在关联。然而，由于这些病原体常被纳入性传播感染（STI）的多重聚合酶链反应（PCR）检测中，因此对它们的检测和报告仍很常见。我们调查了解脲支原体、人型支原体和微小脲原体是否与非孕妇就诊于性健康服务机构时的症状和/或体征有关。
符合条件的女性在墨尔本性健康中心完成了一份关于性行为和症状的问卷。有症状的女性接受了检查。对细菌性阴道病（BV）和外阴阴道念珠菌病（VVC）进行了评估，并使用商业多重 PCR 检测了解脲支原体、人型支原体、微小脲原体以及 4 种非病毒性 STI。
对 1272 名女性进行了分析。在调整了 STI 和 VVC 后，解脲支原体与异常阴道分泌物（优势比[OR] = 2.70，95%置信区间[CI]：1.92-3.79）、阴道异味（OR = 4.27，95%CI：3.08-5.91）、阴道 pH 值>4.5（OR = 4.27，95%CI：3.22-5.66）和线索细胞存在（OR = 8.08，95%CI：5.68-11.48）有关。脲原体属与症状/体征无关。细菌性阴道病与解脲支原体密切相关（OR = 8.01，95%CI：5.99-10.71），但与任何脲原体属无关。在分层分析中，解脲支原体与 BV 女性患者自述的阴道异味和临床医生记录的阴道分泌物有关，但与无 BV 的女性患者的症状/体征无关。
只有解脲支原体与症状/体征有关，这些症状/体征是细菌性阴道病的表现。重要的是，解脲支原体与无细菌性阴道病的女性的症状/体征无关。这些结果不支持对非孕妇常规检测解脲支原体、人型支原体和微小脲原体。
