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: 10616677
• 负责人: Lisa E Manhart
• 金额: $ 61.9万
• 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/10616677
• 关键词: Address; Age; Agreement; Antibiotics; Antibodies; Antimicrobial Resistance; Bacteria; 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; chronic pelvic pain; cost effectiveness; emerging pathogen; experience; high risk; high risk population; improved; infection risk; lifetime risk; male; mathematical model; men; national surveillance; novel; population based; pressure; prevention effectiveness; programs; quinolone resistance; reproductive tract; routine screening; screening; screening guidelines; seropositive; sex; sexually active; transmission process; young man; Address; Age; Agreement; Antibiotics; Antibodies; Antimicrobial Resistance; Bacteria; 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; chronic pelvic pain; cost effectiveness; emerging pathogen; experience; high risk; high risk population; improved; infection risk; lifetime risk; male; mathematical model; men; national surveillance; novel; population based; pressure; prevention effectiveness; 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 大量发病率和医疗保健费用与沙眼衣原体（CT）和支原体有关 生殖器（MG）感染。每种都与雄性和女性生殖道综合症有关 提出了控制的独特挑战。 CT是最常见的全国性通知状况 美国，是骨盆炎性疾病（PID）和不育症的已知原因。尽管长期控制 计划，CT费率处于历史最高范围，CT预防工作的实用性和成本效益是 辩论。由于大多数CT感染都是不对称的，因此我们目前对流行病学和 CT控制程序的有效性完全取决于通过筛查的病例检测，这只是 针对选择人群（妇女<25岁，其他高风险人）。关于CT的了解少得多 ≥25岁的女性不经常筛查，并且不建议与男性进行性爱的男性进行筛查 妇女（MSW）。我们理解中的这些主要差距限制了我们有效针对CT预防的能力 对感染风险最高的男女计划。 MG是最近出现的病原体，负责 男性尿道炎的20-30％。没有国家MG监视和使命一般协议 导致男性尿道炎，关于它是否导致女性后遗症尚无共识。人口有限 存在基于泌尿生殖器Mg患病率的估计值 PID和不育的经验，只允许部分理解人群水平的流行病学。 Mg中的抗菌耐药性（AMR）正在迅速扩展-MG是CDC 2019的三种细菌之一 观察AMR威胁清单 - 但AMR患病率估计值来自高风险性病诊所 而且没有全国代表性的数据。更好地理解人口级的流行病学 CT和MG对于改善每个人的控制工作至关重要。为了实现这一目标，我们将进行血清ePIDEMIologic 国家健康和营养考试调查（NHANES）2017-2018周期的研究，使用新颖 CT的血清学分析区分IgG同种型以区分最近的Disstant感染，而更多 敏感和特异性的MG。我们还将在MG阳性人员的尿液标本中识别AMR 在NHANES 2017-2018中。最后，我们将开发一个基于个体的CT和MG传输动力学模型。 使用这些输出，我们将（1）估计美国男性CT的终生患病率并表征因素 与最近的男女感染有关； （2）估计血清阳性和 美国男性和女性中MG感染的相关性，确定先前的MG感染与 自我报告的PID和不育，以及估计大环内酯类和奎诺酮抗性的患病率和相关性 在毫克（3）评估CT和MG筛查方案对复制健康和治疗的影响 数学模型的结果。这些数据将提供关键信息以支持或更改当前 CT筛查指南，并为新生的国家测试和MG的治疗建议提供信息。