Cumulative burden of Chlamydia trachomatis and Mycoplasma genitalium in the US: implications for screening guidelines and antimicrobial resistance

美国沙眼衣原体和生殖支原体的累积负担：对筛查指南和抗菌素耐药性的影响

• 批准号: 10397644
• 负责人: Lisa E Manhart
• 金额: $ 65.03万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10397644
• 关键词: Address; Age; Agreement; Antibiotics; Antibodies; Antimicrobial Resistance; Bacteria; Centers for Disease Control and Prevention (U.S.); Characteristics; Chlamydia; Chlamydia trachomatis; Clinic; Clinic Visits; Consensus; Data; Detection; Diagnosis; Distant; Ectopic Pregnancy; Effectiveness; Epidemiology; Female; Female infertility; General Population; Genitourinary system; Guidelines; Health Care Costs; High Risk Woman; IgG3; Immunoglobulin G; Incidence; Individual; Infection; Infertility; Macrolide-resistance; Modeling; Morbidity - disease rate; Mycoplasma genitalium; National Health and Nutrition Examination Survey; Output; Patient Self-Report; Pelvic Inflammatory Disease; Persons; Population; Prevalence; Prevention; Prevention program; Public Health; Recommendation; Recording of previous events; Reporting; Reproductive Health; Reproductive Tract Infections; Role; Seroepidemiologic Studies; Serology test; Seroprevalences; Serum; Sexually Transmitted Diseases; Specimen; Syndrome; Testing; Time; Treatment outcome; Urethritis; Urine; Woman; Work; aged; base; chronic pelvic pain; cost effectiveness; experience; high risk; high risk population; improved; infection risk; lifetime risk; male; mathematical model; men; national surveillance; novel; pathogen; population based; pressure; programs; quinolone resistance; reproductive tract; routine screening; screening; screening guidelines; seropositive; sex; sexually active; transmission process; young man

ABSTRACT Significant morbidity and health care costs are associated with Chlamydia trachomatis (CT) and Mycoplasma genitalium (MG) infections. Each is associated with male and female reproductive tract syndromes, yet each presents unique challenges for control. CT is the most commonly reported nationally notifiable condition in the US and is a known cause of pelvic inflammatory disease (PID) and infertility. Despite longstanding control programs, CT rates are at an all-time high and the utility and cost-effectiveness of CT prevention efforts are debated. As most CT infections are asymptomatic, our current understanding of the epidemiology and the effectiveness of CT control programs has depended entirely on case detection through screening, which is only targeted to select populations (women <25 years and other high risk persons). Much less is known about CT in women ≥25 who are infrequently screened, and screening is not recommended for men who have sex with women (MSW). These major gaps in our understanding have limited our ability to effectively target CT prevention programs to men and women at highest risk of infection. MG is a more recently emerged pathogen, responsible for 20-30% of male urethritis. There is no national MG surveillance and, despite general agreement that MG causes male urethritis, there is no consensus about whether it causes sequelae in women. Limited population based estimates of urogenital MG prevalence exist, yet prevalent infections are often a poor predictor of lifetime experience of PID and infertility and permit only partial understanding of population-level epidemiology. Antimicrobial resistance (AMR) in MG is rapidly expanding - MG is one of three bacteria on the CDC's 2019 Watch List of AMR threats - but AMR prevalence estimates are derived from high-risk STD clinic populations and there are no nationally representative data. A better understanding of the population-level epidemiology of CT and MG is critical to improving control efforts for each. To achieve this, we will conduct a seroepidemiologic study in the National Health and Nutrition Examinations Survey (NHANES) 2017-2018 cycle, using a novel serologic assay for CT that differentiates IgG isotypes to distinguish recent from distant infection, and a more sensitive and specific seroassay for MG. We will also identify AMR in urine specimens from MG-positive persons in NHANES 2017-2018. Finally, we will develop an individual-based CT and MG transmission dynamics model. Using these outputs, we will (1) estimate the lifetime prevalence of CT in US men and characterize factors associated with recent versus past infection among men and women; (2) estimate the seroprevalence and correlates of MG infection in US men and women, determine the association between prior MG infection and self-reported PID and infertility, and estimate prevalence and correlates of macrolide and quinolone resistance in MG; (3) evaluate the impact of CT and MG screening scenarios on reproductive health and treatment outcomes in mathematical models. These data will provide critical information to either support or change current CT screening guidelines, and to inform nascent national testing and treatment recommendations for MG.

抽象的 显着的发病率和医疗费用与沙眼衣原体 (CT) 和支原体有关 生殖器 (MG) 感染均与男性和女性生殖道综合征相关。 CT 给控制带来了独特的挑战。 CT 是最常报告的国家须通报的疾病。 尽管长期受到控制，但它是盆腔炎（PID）和不孕症的已知原因。 计划中，CT 率处于历史最高水平，CT 预防工作的实用性和成本效益 由于大多数 CT 感染都是无症状的，因此我们目前对流行病学和流行病学的理解存在争议。 CT控制计划的有效性完全取决于通过筛查发现病例，这只是 针对特定人群（<25 岁的女性和其他高危人群），人们对 CT 的了解知之甚少。 不经常筛查的 ≥25 岁女性，不建议与性行为的男性进行筛查 我们认识上的这些重大差距限制了我们有效针对 CT 预防的能力。 针对感染风险最高的男性和女性的计划 MG 是一种最近出现的病原体。 20-30% 的男性尿道炎没有国家 MG 监测，尽管普遍认为 MG 存在。 引起男性尿道炎，但对女性是否引起后遗症尚无共识。 对泌尿生殖道 MG 患病率的估计是存在的，但流行的感染往往不能很好地预测寿命 PID 和不孕症的经验，只能部分了解人群层面的流行病学。 MG 中的抗生素耐药性 (AMR) 正在迅速扩大 - MG 是 CDC 2019 年公布的三种细菌之一 AMR 威胁观察列表 - 但 AMR 患病率估计值来自高危 STD 诊所人群 并且没有全国代表性的数据来​​更好地了解人口层面的流行病学。 CT 和 MG 对于改善两者的控制工作至关重要。为了实现这一目标，我们将进行血清流行病学调查。 2017-2018 年国家健康和营养检查调查 (NHANES) 周期中的研究，使用了一种新颖的 CT 血清学检测可区分 IgG 同型，以区分近期感染和远处感染，以及更多 我们还将鉴定 MG 阳性者尿液样本中的 AMR。 最后，我们将开发基于个体的 CT 和 MG 传输动力学模型。 利用这些输出，我们将 (1) 估计美国男性终生 CT 患病率和特征因素 与男性和女性近期和过去的感染相关；(2) 估计血清流行率和 美国男性和女性 MG 感染的相关性，确定既往 MG 感染与 自我报告的 PID 和不孕症，并估计大环内酯类和喹诺酮类药物耐药性的患病率和相关性 (3) 评估 CT 和 MG 筛查方案对生殖健康和治疗的影响 这些数据将为支持或改变当前的情况提供关键信息。 CT 筛查指南，并为新的国家 MG 检测和治疗建议提供信息。