SwePub - sökning: WFRF:(Björnelius Eva)

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1.	Björnelius, Eva (författare) Clinical aspects of Mycoplasma genitalium infection 2010 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract The microorganism Mycoplasma (M.) genitalium was first isolated by culture in 1980. Further attempts to culture this mycoplasma were difficult because of its slow growing nature. The development of polymerase chain reaction methods has made it possible to detect M. genitalium more readily but yet there are no commercial tests available. M. genitalium is sexually transmitted and is an independent cause of non-gonococcal urethritis in men and most likely of cervicitis in women. There is accumulating evidence that M. genitalium might play a role as an important agent causing upper genital tract infections in women with possible sequelae like those found after Chlamydia (C.) trachomatis infections. In this thesis various clinical aspects of M. genitalium infection have been elucidated in patients attending our clinic for sexually transmitted infections (STI-clinic). Paper I: M. genitalium among male patients was found to be associated with nonchlamydial non-gonoccocal urethritis. M. genitalium positive patients also more often had a history of recurrent urethritis compared to controls. Paper II: First void urine (FVU) specimens were found superior to urethral swab specimens in male patients to detect M. genitalium; giving a relative sensitivity of 98 % with the first test regime compared to 89 % with the latter. Among female patients the highest sensitivity was accomplished when a FVU specimen was supplemented with a cervical swab specimen. Paper III: A patient with a unilateral conjunctivitis and a concomitant urethritis was found to be infected with M. genitalium. Identical DNA sequences were found in the eye and the genital tract. After antibiotic treatment the symptoms cleared and tests of cure became negative for M. genitalium at both sites. This is the first publication of M. genitalium associated conjunctivitis. Paper IV: Antibiotic treatment of M. genitalium was studied. Treatment with doxycycline was found much less effective as compared to azithromycin in both men and women. The highest clearance rate was achieved when azithromycin was given in a dose of 500 mg day 1 followed by 250 mg days 2-5. This regimen is today recognized as the treatment of choice for M. genitalium infections. The clinical findings after treatment were poor predictors of successful outcome. Paper V: The clinical findings in women infected with M. genitalium as compared to women with chlamydial infection or women uninfected with these organisms were studied. There were only minor differences in the clinical appearance between these groups regarding symptoms and signs of lower genital tract infection. A substantial number of both M. genitalium and C. trachomatis positive women were symptomless. Thus, in order to detect Mycoplasma genitalium infections in women, as is the case with C. trachomatis infections, tests should be used on wide indications. Conclusions: We recommend a generous testing of men and women for M. genitalium regardless of signs and symptoms - if tests are available! We recommend azithromycin orally 500 mg day 1 followed by 250 mg daily for 4 days as the first line treatment of M. genitalium infection in Sweden.
2.	Hjorth, SV, et al. (författare) Sequence-based typing of Mycoplasma genitalium reveals sexual transmission 2006 Ingår i: Journal of Clinical Microbiology. - 0095-1137 .- 1098-660X. ; 44:6, s. 2078-2083 Tidskriftsartikel (refereegranskat)abstract Mycoplasma genitalium causes male nonchlamydial, nongonococcal urethritis and is associated with cervicitis and pelvic inflammatory disease in women. Epidemiological studies indicate that M. genitalium is sexually transmitted, and the aim of the present study was to further substantiate this by means of a DNA typing system. A typing assay based on a diagnostic mgpB gene PCR was developed, evaluated, and applied directly to urogenital specimens. The assay had a low limit of detection and hence a high typeability. Sequences of isolates from 52 unrelated patients were divided into 29 different sequence types, giving a discriminatory index of 0.95. Two to six M. genitalium-positive specimens were collected from each of 44 patients over a median interval of 56 days (range, 11 to 1,395). Forty had the same sequence type in consecutive specimens. Specimens collected from two men were repeatedly positive at intervals of 472 and 1,395 days, respectively, but the sequence types had changed. A new strain was introduced in one sexual dyad, and the sequence types changed subsequently. Seventy-nine M. genitalium-positive specimens from 19 couples were investigated, and all partners initially had concordant sequence types, but one couple had discordant types at one time point before a newly introduced strain took over. The present typing system is simple and reproducible and has an excellent discriminatory capacity which might prove useful in studies of sexual networks and for evaluation of treatment failures. In the laboratory, this system may document the uniqueness of newly isolated M. genitalium strains.

Björnelius, Eva (författare)
Clinical aspects of Mycoplasma genitalium infection
2010
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The microorganism Mycoplasma (M.) genitalium was first isolated by culture in 1980. Further attempts to culture this mycoplasma were difficult because of its slow growing nature. The development of polymerase chain reaction methods has made it possible to detect M. genitalium more readily but yet there are no commercial tests available. M. genitalium is sexually transmitted and is an independent cause of non-gonococcal urethritis in men and most likely of cervicitis in women. There is accumulating evidence that M. genitalium might play a role as an important agent causing upper genital tract infections in women with possible sequelae like those found after Chlamydia (C.) trachomatis infections. In this thesis various clinical aspects of M. genitalium infection have been elucidated in patients attending our clinic for sexually transmitted infections (STI-clinic). Paper I: M. genitalium among male patients was found to be associated with nonchlamydial non-gonoccocal urethritis. M. genitalium positive patients also more often had a history of recurrent urethritis compared to controls. Paper II: First void urine (FVU) specimens were found superior to urethral swab specimens in male patients to detect M. genitalium; giving a relative sensitivity of 98 % with the first test regime compared to 89 % with the latter. Among female patients the highest sensitivity was accomplished when a FVU specimen was supplemented with a cervical swab specimen. Paper III: A patient with a unilateral conjunctivitis and a concomitant urethritis was found to be infected with M. genitalium. Identical DNA sequences were found in the eye and the genital tract. After antibiotic treatment the symptoms cleared and tests of cure became negative for M. genitalium at both sites. This is the first publication of M. genitalium associated conjunctivitis. Paper IV: Antibiotic treatment of M. genitalium was studied. Treatment with doxycycline was found much less effective as compared to azithromycin in both men and women. The highest clearance rate was achieved when azithromycin was given in a dose of 500 mg day 1 followed by 250 mg days 2-5. This regimen is today recognized as the treatment of choice for M. genitalium infections. The clinical findings after treatment were poor predictors of successful outcome. Paper V: The clinical findings in women infected with M. genitalium as compared to women with chlamydial infection or women uninfected with these organisms were studied. There were only minor differences in the clinical appearance between these groups regarding symptoms and signs of lower genital tract infection. A substantial number of both M. genitalium and C. trachomatis positive women were symptomless. Thus, in order to detect Mycoplasma genitalium infections in women, as is the case with C. trachomatis infections, tests should be used on wide indications. Conclusions: We recommend a generous testing of men and women for M. genitalium regardless of signs and symptoms - if tests are available! We recommend azithromycin orally 500 mg day 1 followed by 250 mg daily for 4 days as the first line treatment of M. genitalium infection in Sweden.

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