1
|
Feng C, Li R, Shamim AA, Ullah MB, Li M, Dev R, Wang Y, Zhao T, Liao J, Du Z, Ling Y, Lai Y, Hao Y. High-resolution mapping of reproductive tract infections among women of childbearing age in Bangladesh: a spatial-temporal analysis of the demographic and health survey. BMC Public Health 2021; 21:342. [PMID: 33579253 PMCID: PMC7881647 DOI: 10.1186/s12889-021-10360-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 01/31/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reproductive tract infections (RTIs) have become major but silent public health problems devastating women's lives in Bangladesh. Accurately and precisely identifying high-risk areas of RTIs through high-resolution risk maps is meaningful for resource-limited settings. METHODS We obtained data reported with RTI symptoms by women of childbearing age in the years 2007, 2011 and 2014 from Bangladesh Demographic and Health Survey. High-spatial Environmental, socio-economic and demographic layers were downloaded from different open-access data sources. We applied Bayesian spatial-temporal models to identify important influencing factors and to estimate the infection risk at 5 km spatial resolution across survey years in Bangladesh. RESULTS We estimated that in Bangladesh, there were approximate 11.1% (95% Bayesian credible interval, BCI: 10.5-11.7%), 13.9% (95% BCI: 13.3-14.5%) and 13.4% (95% BCI: 12.8-14.0%) of women of childbearing age reported with RTI symptoms in 2007, 2011 and 2014, respectively. The risk of most areas shows an obvious increase from 2007 to 2011, then became stable between 2011 and 2014. High risk areas were identified in the southern coastal areas, the western Rajshahi Division, the middle of Khulna Division, and the southwestern Chittagong Division in 2014. The prevalence of Rajshahi and Nawabganj District were increasing during all the survey years. CONCLUSION The high-resolution risk maps of RTIs we produced can guide the control strategies targeted to priority areas cost-effectively. More than one eighth of women of childbearing age reported symptoms suggesting RTIs and the risk of RTIs varies in different geographical area, urging the government to pay more attention to the worrying situation of female RTIs in the country.
Collapse
Affiliation(s)
- Chenyang Feng
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Ruixue Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Department of Information, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, China
| | - Abu Ahmed Shamim
- James P Grant School of public Health, BRAC University, Dhaka, Bangladesh
| | - Md Barkat Ullah
- Department of Nutrition, University of California Davis, California, USA
| | - Mengjie Li
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Rubee Dev
- Dhulikhel Hospital, Kathmandu University Hospital, Kavre, Nepal
| | - Yijing Wang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Tingting Zhao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jing Liao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| | - Zhicheng Du
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yuheng Ling
- CNRS UMR 6240, Universite de Corse Pascal Paoli, 20250, Corti, France
| | - Yingsi Lai
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China. .,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China.
| | - Yuantao Hao
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China.,Sun Yat-sen Global Health Institute, Sun Yat-Sen University, Guangzhou, China
| |
Collapse
|
2
|
Lillis RA, Martin DH, Nsuami MJ. Mycoplasma genitalium Infections in Women Attending a Sexually Transmitted Disease Clinic in New Orleans. Clin Infect Dis 2020; 69:459-465. [PMID: 30351348 DOI: 10.1093/cid/ciy922] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 10/22/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mycoplasma genitalium has been significantly and nonsignificantly associated with cervicitis, urethritis, or vaginal discharge. This study examined the associations of M. genitalium with selected sexually transmitted infections (STIs) and demographic, behavioral, and clinical factors among women attending a sexually transmitted disease (STD) clinic in New Orleans. METHODS Women aged ≥18 years who presented to the New Orleans STD clinic provided sociodemographic data and sexual behavior; STI, obstetric, and gynecologic history; and urine, vaginal, endocervical, and rectal specimens. Specimens were tested for M. genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma hominis, Ureaplasma species, and yeast. Bacterial vaginosis (BV) was diagnosed by Nugent score, and cervicitis was defined as ≥30 polymorphonuclear leukocytes per high-power microscopic field on a cervical Gram stain or yellow mucopus on an endocervical swab. RESULTS Among 400 women studied, M. genitalium was independently significantly associated with age <25 years (P < .03) and with ≥2 sexual partners in the last 12 months (P < .003). Neisseria gonorrhoeae (adjusted odds ratio [AOR], 1.75; P = .103), C. trachomatis (AOR, 1.43; P = .247), and T. vaginalis (AOR, 1.60; P = .120) independently increased the odds of infection with M. genitalium. Controlling for other STIs and BV, there was a positive trend for M. genitalium to predict cervicitis (AOR, 3.18 [95% confidence interval, .99-10.2]; P = .05). CONCLUSIONS Mycoplasma genitalium in our study displayed the clinical features of C. trachomatis and N. gonorrhoeae, the 2 organisms that drive research agendas in diagnosis, treatment, and prevention of bacterial STIs.
Collapse
Affiliation(s)
- Rebecca A Lillis
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David H Martin
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana.,Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - M Jacques Nsuami
- Department of Medicine, Section of Infectious Diseases, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| |
Collapse
|
3
|
Coudray MS, Madhivanan P. Bacterial vaginosis-A brief synopsis of the literature. Eur J Obstet Gynecol Reprod Biol 2020; 245:143-148. [PMID: 31901667 PMCID: PMC6989391 DOI: 10.1016/j.ejogrb.2019.12.035] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 12/09/2019] [Accepted: 12/23/2019] [Indexed: 12/12/2022]
Abstract
Bacterial vaginosis (BV) affects women of reproductive age and can either be symptomatic or asymptomatic. Approximately 50 % of women are symptomatic and experience vaginal malodor, discharge, itching and increased vaginal pH. BV can increase the risk of contracting many sexually transmitted infections (STIs) such as human immunodeficiency virus (HIV), Neisseria gonorrhea (NG), Chlamydia trachomatis (CT), Trichomonas vaginalis (TV) and herpes simplex virus-2 (HSV-2). Though effective treatment options do exist, metronidazole or clindamycin, these methods have proven not to be effective long term. The purpose of this review is to summarize current literature on the epidemiology of BV and highlight areas of deficiency in current clinical practice with respect to BV. BV recurrence rates are high, approximately 80 % three months after effective treatment. Furthermore, in some instances treatment is ineffective and BV persists. Literature also documents the relationship between BV and human papillomavirus (HPV). HPV is the most common sexually transmitted infection among young adult women while BV is the most common cause of vaginal symptoms among women of reproductive age. BV is associated with high levels of anaerobic organisms which can damage the vaginal epithelium and increase the risk of HPV infection. Recent research also highlights the role of the vaginal microbiome in BV. The results of this review warrant further exploration into the etiology of BV as well as exploration of more long-term effective treatment and the investigation of prognostic indicators. Additionally, the need for a standard definition of recurrent and persistent BV is recognized.
Collapse
Affiliation(s)
- Makella S Coudray
- Department of Epidemiology, Stempel College of Public Health and Social Work, Florida International University, USA.
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, USA; Internal Medicine, Division of Infectious Diseases, College of Medicine, University of Arizona, Tuscon, Arizona, USA; Public Health Research Institute of India, Mysore, Karnataka, India; Family & Community Medicine, College of Medicine, University of Arizona, Tuscon, Arizona, USA
| |
Collapse
|
4
|
Golden MR, Workowski KA, Bolan G. Developing a Public Health Response to Mycoplasma genitalium. J Infect Dis 2017; 216:S420-S426. [PMID: 28838079 DOI: 10.1093/infdis/jix200] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although Mycoplasma genitalium is increasingly recognized as a sexually transmitted pathogen, at present there is no defined public health response to this relatively newly identified sexually transmitted infection. Currently available data are insufficient to justify routinely screening any defined population for M. genitalium infection. More effective therapies, data on acceptability of screening and its impact on clinical outcomes, and better information on the natural history of infection will likely be required before the value of potential screening programs can be adequately assessed. Insofar as diagnostic tests are available or become available in the near future, clinicians and public health agencies should consider integrating M. genitalium testing into the management of persons with sexually transmitted infection (STI) syndromes associated with the infection (ie urethritis, cervicitis, and pelvic inflammatory disease) and their sex partners. Antimicrobial-resistant M. genitalium is a significant problem and may require clinicians and public health authorities to reconsider the management of STI syndromes in an effort to prevent the emergence of ever more resistant M. genitalium infections.
Collapse
Affiliation(s)
- Matthew R Golden
- Center for AIDS and STD, University of Washington, Seattle.,Public Health - Seattle & King County, Washington
| | - Kimberly A Workowski
- Department of Infectious Diseases, Emory School of Medicine.,Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gail Bolan
- Centers for Disease Control and Prevention, Atlanta, Georgia
| |
Collapse
|
5
|
Molaei B, Mohmmadian F, Eftekhar M, Hatami R, Tirkan A, Kiani M. The frequency of gonorrheal and chlamydial infections in Zanjanian women in 2013-2014. Int J Reprod Biomed 2017. [DOI: 10.29252/ijrm.15.2.75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
6
|
The Prevalence of Neisseria gonoroheae among Iranian Women by Phenotyping and Genotyping Methods. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2016. [DOI: 10.22207/jpam.10.4.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Kenyon C, Colebunders R, Crucitti T. The global epidemiology of bacterial vaginosis: a systematic review. Am J Obstet Gynecol 2013; 209:505-23. [PMID: 23659989 DOI: 10.1016/j.ajog.2013.05.006] [Citation(s) in RCA: 240] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/12/2013] [Accepted: 05/02/2013] [Indexed: 11/20/2022]
Abstract
Bacterial vaginosis (BV) enhances the acquisition and transmission of a range of sexually transmitted infections including human immunodeficiency virus. This has made it more important to uncover the reasons why some populations have very high BV prevalences and others not. This systematic review describes the global epidemiology of BV. It summarizes data from peer-reviewed publications detailing the population prevalence of BV as diagnosed by a standardized and reproducible methodology-Nugent scoring system. BV variations between countries, and between ethnic groups within countries, are described. We evaluated 1692 English- and non-English-language articles describing the prevalence of BV using MEDLINE and the Web of Science databases. A total of 86 articles met our inclusion criteria. BV prevalences were found to vary considerably between ethnic groups in North America, South America, Europe, the Middle East, and Asia. Although BV prevalence is, in general, highest in parts of Africa and lowest in much of Asia and Europe, some populations in Africa have very low BV prevalences and some in Asia and Europe have high rates.
Collapse
Affiliation(s)
- Chris Kenyon
- HIV/STD Unit, Institute of Tropical Medicine, Antwerp, Belgium; Division of Infectious Diseases and HIV Medicine, University of Cape Town, Cape Town, South Africa.
| | | | | |
Collapse
|
8
|
Fule SR, Fule RP, Tankhiwale NS. Clinical and laboratory evidence of Trichomonas vaginalis infection among women of reproductive age in rural area. Indian J Med Microbiol 2013; 30:314-6. [PMID: 22885198 DOI: 10.4103/0255-0857.99493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Vaginitis is a commonly encountered complaint and one of the most frequent reasons for patient visit to obstetrician-gynaecologists. Three vaginal infections are frequent causes of a vaginal discharge: (1) bacterial vaginosis, (2) vulvovaginal candidiasis and (3) trichomonas vaginitis. Differences in the clinical presentation are helpful in diagnosis. Characteristic signs and symptoms for these three vaginal infections are distinct, but on many occasions, they are overlapping. The aim of the present study was to find the prevalence and correlation between the clinical spectrum and laboratory evidence of Trichomonas vaginalis infection by simple, reliable, confirmatory and specific method, i.e. microscopic examination of wet mount preparation and acridine stain of vaginal fluid. MATERIALS AND METHODS Irrespective of HIV status, a total of 156 women with vaginal discharge were studied for establishing diagnosis of genital tract infection. The cases of bacterial vaginosis and vulvovaginal candidiasis were excluded from the study. Vaginal speculum assisted high vaginal swabs were collected from women with discharge, during collection vagina was inspected for obvious signs. RESULTS Of the 156 women with vaginal discharge, 19 (12.06 %) showed T. vaginalis infection. All the women belonged to active reproductive age group, i.e. 20-40 years. Itching dysuria, and offensive, malodorous, thin, yellowish vaginal discharge were the main and consistent complaints. Only in 2 (1.52%) cases, vaginal speculum examination revealed erythema and punctuate haemorrhage, the so-called "strawberry' vagina. The pH was recorded to be >4.5. CONCLUSION Clinical differentiation of various forms of infectious vaginitis is unreliable. The prevalence of T. vaginalis infection at 12.06% was found among rural young women of reproductive age using simple and reliable screening wet mount microscopy.
Collapse
Affiliation(s)
- S R Fule
- Department of Microbiology, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
| | | | | |
Collapse
|
9
|
Ouzounova-Raykova V, Jordanov D, El-Tibi M, Mitov I. Gonococcal infection in symptomatic and asymptomatic persons seeking medical clinics in Sofia--a 3-year study 2008-2010. APMIS 2011; 119:864-7. [PMID: 22085362 DOI: 10.1111/j.1600-0463.2011.02769.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim was to determine the prevalence of gonococcal infection and to compare the results with those received by other researchers, because in Bulgaria a good medical practice for the laboratory confirmation, report and therapy is lacking. A total of 617 specimens from symptomatic and asymptomatic persons attending clinics in Sofia from January 2008 to December 2010 were tested by culture and in-house PCR. Using PCR Neisseria gonorrhoeae was identified in six urethral (6.25%) and eight (1.54%) cervical specimens. By applying culture method, N. gonorrhoeae positive result was found in 12 swabs--one cervical and one urethral swab less. The positive results correspond predominantly to persons with genital complains and suspicions for gonococcal or other sexually transmitted infection. This is the first study in Bulgaria since 1989 and determines the prevalence of N. gonorrhoeae to 2.3% over a 3-year period. Detection by culture was slightly less sensitive than by nucleic acid amplification test (NAAT). Continuous monitoring of gonorrhea by culture and NAAT is important for public health in Bulgaria.
Collapse
|
10
|
Weinstein SA, Stiles BG. A review of the epidemiology, diagnosis and evidence-based management of Mycoplasma genitalium. Sex Health 2011; 8:143-58. [PMID: 21592428 DOI: 10.1071/sh10065] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2010] [Accepted: 08/30/2010] [Indexed: 11/23/2022]
Abstract
Mycoplasma genitalium is attracting increasing recognition as an important sexually transmitted pathogen. Presented is a review of the epidemiology, detection, presentation and management of M. genitalium infection. Accumulating evidence suggests that M. genitalium is an important cause of non-gonococcal, non-chlamydial urethritis and cervicitis, and is linked with pelvic inflammatory disease and, possibly, obstetric complications. Although there is no standard detection assay, several nucleic acid amplification tests have >95% sensitivity and specificity for M. genitalium. To date, there is a general lack of established protocols for screening in public health clinics. Patients with urethritis or cervicitis should be screened for M. genitalium and some asymptomatic sub-groups should be screened depending on individual factors and local prevalence. Investigations estimating M. genitalium geographic prevalence document generally low incidence, but some communities exhibit infection frequencies comparable to that of Chlamydia trachomatis. Accumulating evidence supports an extended regimen of azithromycin for treatment of M. genitalium infection, as data suggest that stat 1 g azithromycin may be less effective. Although data are limited, azithromycin-resistant cases documented to date respond to an appropriate fluoroquinolone (e.g. moxifloxacin). Inconsistent clinical recognition of M. genitalium may result in treatment failure and subsequent persistence due to ineffective antibiotics. The contrasting nature of existing literature regarding risks of M. genitalium infection emphasises the need for further carefully controlled studies of this emerging pathogen.
Collapse
Affiliation(s)
- Scott A Weinstein
- Women's and Children's Hospital, 72 King William Road, North Adelaide, SA 5003, Australia.
| | | |
Collapse
|
11
|
Ouzounova-Raykova VV, El Tibi M, Mitov IG. The first simultaneous study of the prevalence of Neisseria gonorrhoeae and Chlamydia trachomatis infections by polymerase chain reaction and standard methods. Sex Health 2011; 8:442-4. [PMID: 21851790 DOI: 10.1071/sh11056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2011] [Accepted: 04/07/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND Neisseria gonorrhoeae and Chlamydia trachomatis are important sexually transmissible pathogens. The aim of the present study was to determine their prevalence in symptomatic and asymptomatic people. METHODS Polymerase chain reaction (PCR) and standard methods were tested for 413 specimens. RESULTS The registered prevalence with PCR was N. gonorrhoeae 2.66% and C. trachomatis 0.73%. One man showed co-infection. Standard methods demonstrated lower sensitivity in finding N. gonorrhoeae and C. trachomatis in comparison with the PCR. CONCLUSIONS This is the first simultaneous study in Bulgaria for detection of N. gonorrhoeae and C. trachomatis by PCR and standard methods. N. gonorrhoeae was found to be a more frequent infection. Further investigations are needed.
Collapse
|
12
|
Abstract
Mycoplasma genitalium is an emerging sexually transmitted pathogen implicated in urethritis in men and several inflammatory reproductive tract syndromes in women including cervicitis, pelvic inflammatory disease (PID), and infertility. This comprehensive review critically examines epidemiologic studies of M. genitalium infections in women with the goal of assessing the associations with reproductive tract disease and enhancing awareness of this emerging pathogen. Over 27,000 women from 48 published reports have been screened for M. genitalium urogenital infection in high- or low-risk populations worldwide with an overall prevalence of 7.3% and 2.0%, respectively. M. genitalium was present in the general population at rates between those of Chlamydia trachomatis and Neisseria gonorrhoeae. Considering more than 20 studies of lower tract inflammation, M. genitalium has been positively associated with urethritis, vaginal discharge, and microscopic signs of cervicitis and/or mucopurulent cervical discharge in seven of 14 studies. A consistent case definition of cervicitis is lacking and will be required for comprehensive understanding of these associations. Importantly, evidence for M. genitalium PID and infertility are quite convincing and indicate that a significant proportion of upper tract inflammation may be attributed to this elusive pathogen. Collectively, M. genitalium is highly prevalent in high- and low-risk populations, and should be considered an etiologic agent of select reproductive tract disease syndromes in women.
Collapse
Affiliation(s)
- Chris L McGowin
- Department of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center, New Orleans, Louisiana, United States of America.
| | | |
Collapse
|
13
|
Ouzounova-Raykova VV, Markovska R, Mizgova G, Mitov IG. Detection of the sexually transmissible genital mycoplasmas by polymerase chain reaction in women. Sex Health 2011; 8:445-6. [DOI: 10.1071/sh11044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Accepted: 03/28/2011] [Indexed: 11/23/2022]
Abstract
Background The role of Ureaplasma urealyticum, Mycoplasma hominis and Mycoplasma genitalium in the development of clinical disorders is still unclear. The aim of this study was to determine their prevalence in symptomatic and asymptomatic women. Methods: A total of 348 women were examined by applying polymerase chain reaction (PCR) methods. Results: The registered prevalence was as follows: U. urealyticum 14.66%; M. hominis 3.16%; and M. genitalium 0.29%. Co-infection was established in 11 swabs. Conclusions: This is the first study in Bulgaria for the detection of mycoplasmas by PCR. Our results demonstrate similar or lower values in comparison with other researchers and further investigations are needed.
Collapse
|