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SS 2017: Mycoplasma genitalium :“Status in South Asia”
1. Mycoplasma genitalium :“Status in South Asia”
Sunil Sethi
Vice Chair , IUSTI AP South Asia Subregion,
Professor, STD division
Department of Medical Microbiology, Postgraduate
Institute of Medical Education and Research,
Chandigarh,India
6. Mycoplasma genitalium
1980: Mycoplasma genitalium isolated from 2 of 13 men
with NGU (nongonoccocal urethritis)
Sexually transmitted bacterium, lacks a cell wall
1990’s: development of PCR assays, allowed study of disease
association
1995: smallest genome known (580 kbp, ≈ 480 genes)
7. M. genitalium contributes to pathogenesis
of several urogenital diseases
9. Worldwide prevalence
EUROPE
Denmark-1.1-2.3 %
Sweden-2.3-7.7 %
Norway-4.47 %
UK-4.5-6.6 %
CENTRAL &
SOUTH AMERICA
Brazil-5.8%
Honduras-7.1%
NORTH AMERICA
USA-5.4-22.4%
AFRICA
Tanzania-3.2-5%
Kenya-16%
Australia-1.3-11%
New Zealand-10%
Middle East
Iran-7.2%
Jordan-9%
Russia-26%
Sex Health. 2011 Jun;8(2):143-58. doi: 10.1071/SH10065
12. South Asia prevalence- Underdiagnosed
Bangladesh- 0.8%
India (Chandigarh 2009)- 6% NGU &
15 % in Infertility and 6% in
cervicitis
N=399
Random sampling of women
at PHC with vaginal disharge
(Rahman et al, 2008)
N=100
Men with NGU at STD/HIV
clinics
(Manhas et al, 2009)
Sex Health. 2011 Jun;8(2):143-58. doi: 10.1071/SH10065
Widely varying prevalence estimates of studies probably reflect
multi-factorial variables among populations tested (e.g. patient
health status and age, assay methods, specimen types)
No studies
13. Epidemiology in South Asia ?
How much ? Prevalence and incidence
Who ? Risk factors
14. Underdiagnosed infection in South Asia?
M. genitalium prevalence among various populations
received relatively little attention
Why?
Lack of standardised testing
Under-reported infections
Lack of awareness
Syndromic approach
16. While C. trachomatis - universally accepted as
an STI,
pathogen status of M. genitalium is not so
prominent
M. genitalium to be regarded more seriously
and to be recognized as a significant STI with
associated morbidity.
17. Association of Mycoplasma genitalium in HIV
positive men with NGU attending HIV and STD
clinics in Northern India
Sunil Sethi, Ashwini Manahas ,Ajay Wanchu*, Kanwar mohan**
and Meera Sharma
Department of Medical Microbiology and Dermatology
**, Internal Medicine* PGIMER, Chandigarh, India
Indian J Med Res 129, March 2009,
pp 305-310
18. Patient population
100 patients (Uretheritis) HIV clinic
HIV negative
(n=30)
•Urethral swabs(n=3) and FVU taken
•Informed consent,detailed clinical history
HIV positive
(n=70)
19.
20. Conclusions of the study
Chlamydia trachomatis (21%) and Ureaplasma
urealyticum (13%) were the most frequently
associated with NGU.
M. genitalium was detected in 6%
HIV positive individuals -7.1%,
HIV negative individuals -3.3% (P>0.05)
Not significantly associated with NGU in either
HIV positive or HIV negative men.
21. Role of Mycoplasma genitalium in Infertility and
Cervicitis in north Indian Women- A pilot Study
Indian J Sex Transm Dis. 2015 Jul-Dec;36(2):144-8. doi:
Sethi S¹,Rajkumari N , Dhaliwal LK², Gupta N³,Yadav R¹,
Banga SS¹, Sharma M¹
¹Department of Medical Microbiology, ²Obstetrics and
Gynaecology, ³Cytology and Gynaecology Pathology,
PGIMER, Chandigarh
24. Conclusions of the study
• Significantly association of M.genitalium with
Infertility and cervicitis
– Infertility -15%(PI-8%, SI-7 %)
– Cervicitis – 6%
• Not much significant findings in HPE(Bx) in
both PI & SI 1.1%, 2.1%)
• However, PAP smear shows significant findings
when correlated(PI-4.3%,SI-8.5%,Cervicitis-
3.2%)
27. Multiplex real-time PCR compared with three
monoplex real-time PCR assay in cervicitis patients
Organisms % Sensitivity % Specificity PPV NPV
C. trachomatis 100 (20/20) 100 (378/378) 100 (20/20) 100 (378/378)
N. gonorrhoeae 100 (18/18) 100 (380/380) 100 (18/18) 100 (380/380)
M. genitalium 90.91 (63/70) 100 (328/328) 100 (63/70) 97.91 (328/335)
28. Commercial assays available but not
used
Kit Principle
MycoSEQ™
Mycoplasma
Detection Assay
Sequencing
AmpliSens®
Mycoplasma
genitalium FRT
Fluorescence real
time
FTD Urethritits
basic
Taqman Chemistry
29. Challenges for diagnosis in South Asian countries
Aymptomatic cases- reservoir of organism
Culture insensitive & extremely slow
NAAT
In house Conventional PCRs – MgPa , 16S rRNA
In house real-time PCR- MgPa, 16S rRNA
In house multiplex PCRs – CT, MG, NG, UU
No commericial assay being used –?cost
Important to validate and quality assure in-house assays
No rapid POC, no serology commercialized
30. Diagnosis of drug resistant Mycoplasma genitalium in South
Asia
lack of data on prevalence of macrolide resistance-associated
mutations among the M. genitalium
Syndromic management for STI control- No diagnostic assay
Role M. genitalium plays reproductive tract morbidity in
resource-poor settings
?what extent M. genitalium strains have acquired
resistance mutations.
No studies reporting macrolide-associated mutations
31. What is required for M.genitalium in South Asian
countries ?
Development and validation of a commercial
multiplex assay M. genitalium - key resistance
mutations-
Automated assays like Genexpert
Systematic screening HRG- MSM for rectal infection
Establishment of local and regional surveillance
networks -prevalence of infection and AMR
Awareness and WHO active participation
32. Summary
M. genitalium- emerging sexually transmitted infections
Established cause of non gonococcal uretheritis (NGU)-Men
Association with mucopurulent cervicitis, infertility quite
convincing
No screening programmes -Largely underdiagnosed infection
in South Asia
Lack of awareness among clinicians
Need of laboratories to perform Quality assured In house
NAAT
No data on drug resistance – emerging
33.
34. Acknowledgements
Dr.J.S Jensen, Staten serum Institute,
Denmark
Margaretha jurstrand, orebro university
hospital, orebro, Sweden