Mycoplasma genus (Mycoplasrnagenitali-um, Mg) belongs to the genus Mycoplasma, a prokaryote between bacteria and viruses, and the 12th mycoplasma found by humans. In 2009, the European guidelines for the treatment of non-gonococcal urethritis (NGU) have clearly identified that Mg is one of the causes of NGU. In 2010, the US CDC also emphasized the pathogenic role of Mg in the diagnosis and treatment of cervicitis. In addition, the diseases associated with Mg are also Including pelvic inflammatory disease (PID), obstetric complications, prostatitis, epididymitis and foreskin balanitis. In recent years, studies have also found that Mg infection may be related to the development of tumors and HIV. Since Tully et al. first isolated and cultured 2 strains of Mg from the urethral secretions of male patients in NGU in 1981, its pathogenicity was determined decades after the isolation of the PCR technique, and many scholars subsequently A great deal of research has been done on the growth characteristics, immunological properties, molecular biological properties, and relationships with diseases of Mg. At the 20th World Dermatology Conference, the pathogenicity of Mg has been raised to a new level. Researchers have established a variety of detection methods for further understanding of Mg. Fluorescence quantitative PCR technology is widely used in experimental research, and its sensitivity and specificity are high. Edwards proposed the use of loop-mediated isothermal amplification (LAMP) for the detection of Mg. The sensitivity and specificity of this method are similar to those of real-time PCR, but the cost is relatively low. Although the relevant detection methods are increasingly rich, from the aspects of technical maturity and experimental cost, there is still no perfect technology that can be applied to clinical diagnosis. This article reviews the related diseases caused by genital mycoplasma and the role of genital mycoplasma in the pathogenesis of the disease.
In recent years, due to the prevalence of Mg infection and the continuous improvement of detection technology, the related literature reports that the infection rate is increasing year by year, ranging from 0 to 47.5% in different population samples. The change is so great because the specimens selected by different studies are different. Secondly, the research populations of different studies are different, and the same population enrollment standards cannot be unified. In addition, the detection techniques of each research are also quite different. McGowin et al. evaluated the prevalence of Mg based on 48 published literatures and found that the low-risk group infection rate was 2.0%, compared with 7.3% in the high-risk group, suggesting that Mg infection may be more prevalent than estimated. These data illustrate the fact that Mg has become an important pathogen in sexually transmitted diseases.
2.Mg caused diseases
2.1 Mg and urethritis
In 2001, Taylor-Rob-inson et al. established the status of Mg in the pathogenicity of urethritis. Later, it is generally accepted that Mg is an important cause of NGU. The pathogen of NGU is more clearly Chlamydia trachomatis. In 2006, it was separately classified as urogenital chlamydia trachomatis infection; in addition, 20% to 50% of patients with NGU are still unclear, and Prenitice recommends this type of urethritis as non-C. trachomatis non-gonococcal urethritis. Mg is the first in all pathogens of NCNGU. In people with sexually transmitted diseases, infection with Mg is more prone to urinary tract fluid symptoms than other pathogen infections, and signs of urethritis can reach 90%. Quantitative PCR confirms the higher number of strains in symptomatic men. In vitro experiments have also confirmed the pathogenicity of Mg. The chimpanzee inoculated with Mg has symptoms of urethritis. The symptoms of infection in these genitourinary tracts are mainly acute inflammatory reactions of polymorphonuclear leukocytes, with specific antibody responses occurring later. These animal experiments are an extension of the Koch hypothesis, and they more fully confirm that Mg is the causative agent of NGU. While Mg infection is more likely to produce persistent or recurrent urethritis after acute infection, clinicians often use azithromycin to treat such urethritis, but some patients with initial negative are prone to turn yang after applying macrolide therapy. Case. Falk et al. conducted a prospective study to find a suitable time for the detection of Mg in Mg-negative NGU patients. It is believed that Mg should be detected 3 to 4 weeks after macrolide treatment. Confirm the presence or absence of turning the sun. Many studies have shown that Mg is one of the pathogens of urethritis, but the detection methods and treatment methods need to be further explored.
2.2 Mg and cervicitis
Recently, the US CDC update on the diagnosis and treatment of cervical inflammation has not changed much, and only on the pathogen, the pathogenic effect of Mg is emphasized. Mg infection is the independent pathogenic factor of cervicitis. Manhartt et al. applied multivariate logistic regression analysis after detecting cervical secretions from females, excluding Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) interference and correcting confounding factors. It is concluded that the risk of Mg infection in women with cervicitis is 70%. China’s Chen Fangru et al. also supported the study of Mg independent of CT. The study population was non-gonococcal non-Chlamydia cervicitis patients. The results showed that the Mg infection rate in the NGNCC group (10.13%) was significantly higher than that in the non-NGNCC group (3.06%) and health. group. A meta-analysis of genital mycoplasma and female genital tract infections by Lis et al. showed that the risk of cervicitis-induced Mg infection was 1.66, which is similar to previous studies and most experimental studies. Most studies support the close relationship between cervicitis and Mg infection, and early and timely treatment is important to prevent pelvic inflammatory disease caused by this bacteria, so clinicians should pay attention to Mg when treating cervicitis.
2.3 Mg and pelvic inflammatory disease
Pelvicin-flammatory disease (PID) refers to a group of infectious diseases in the upper genital tract of women. The “gold standard” for diagnosis is hysteroscopy. Chlamydia trachomatis and Neisseria gonorrhoeae are well known PID pathogens, but apart from these two pathogens, a high proportion of PID causes are unknown. Since the separation of Mg, many researchers have found that Mg is crucial in the development of PID. In 2015, the National Institutes of Health proposed the pathophysiology of PID to determine whether mycoplasma is developing and transgenic in pelvic inflammatory diseases. Centralization plays an important role. Compared with Chlamydia trachomatis and Neisseria gonorrhoeae, the symptoms caused by Mg are mild, often ignored by patients due to mild symptoms, but if left untreated, it will have more serious consequences. The PID pathogenesis is due to the ascending infection of the lower genital tract. After Gowin et al. administered vaginal inoculation of Mg to progesterone-treated or estradiol-treated mice, Mg continued to infect the lower genital tract for 77 days, a few weeks after inoculation. It can be disseminated to the upper genital tract and knee joints; studies have shown that there is a significant correlation between Mg infection and the incidence of pelvic inflammatory disease after abortion. Therefore, Mg infection should be taken seriously in PID therapy.
2.4 Mg and infertility
One of the consensus reached at the 2015 American Reproductive Medicine Association Conference (ASRM) on the diagnosis and treatment of female infertility is that tubal obstruction is an important cause of female infertility, and Baczynskal et al. found that by co-cultivating Mg and human fallopian tube tissue, Mg It can infect the fallopian tubes and produce an inflammatory response. Salpingitis is an important cause of obstruction of the fallopian tubes; however, the existing literature cannot draw definitive conclusions due to the small number of experimental studies. Whether the infection of Mg causes male infertility has not been conclusive. Only a few studies have suggested that male infertility is associated with Mg infection, but these studies are usually not convincing because there is no male control group. It has been reported that 15% of male infertility is associated with genital tract infections, and whether Mg has a certain position in these 15% still requires further research and exploration.
2.5 Mg and obstetric complications
Peuchant et al. concluded in a prospective study that women with a history of abortion were more susceptible to Mg, but were not associated with preterm birth, and that there was a regional difference in the prevalence of Mg among pregnant women. Ma Limin’s research suggests that genital mycoplasma infection is closely related to stillbirth, abortion and low birth weight infants. Tian Yan et al studied 72 patients with premature rupture of membranes. It is suggested that Mg infection may be a cofactor for PROM, and the incidence of preterm birth, puerperal infection, neonatal infection and pathological jaundice in PROM patients is significantly higher than that in the control. group. Therefore, for suspected pregnant women should pay attention to the screening and treatment of Mg infection, it is recommended to routinely collect the secretions of the vagina and cervix for Mg detection.
2.6 Mg and prostatitis
There are not many reports on the relationship between chronic prostatitis and Mg infection, and the opinions are inconsistent. Mandar et al. used 60 cases of male chronic prostatitis (according to the US N/HIIIa standard) to detect Mg in semen by PCR. The positive rate was 18%. Supporting Mg may cause chronic prostatitis. In another study, the researchers used 50 cases of chronic non-bacterial prostatitis to detect prostate tissue under ultrasound control using PCR to detect Mg, but did not detect Mg. There are few related studies in China. Liu Qi and other studies have shown that the detection rate of prostate fluid in the non-bacterial prostatitis group after septic urethritis is 6.4%, and there is no significant difference between the group and the non-prostatitis group. Chronic non-bacterial prostatitis after sexually transmitted urethritis.
2.7 Mg and other diseases
In the development of prostate cancer, ovarian cancer and lymphoma, Mg may also play a certain role. Some scholars have used in vitro culture and ELISA to prove that there may be a relationship between Mg and some tumors; however, some existing experimental studies The results from the small sample size are irrelevant, and so far there is not enough epidemiological evidence to establish the role of Mg in cancer development, and its possible pathogenic mechanism still needs further research and exploration. Horner et al believe that Mg infection may be a cause of asymptomatic proctitis. Others such as acute epididymitis may also be associated with Mg pathogenicity.
2.8 Mg and human immunodeficiency virus (HIV)
HIV is the causative agent of acquired immunodeficiency syndrome (AIDS), and HIV/AIDS has now become a global trend. There are two views on the relationship between Mg infection and HIV infection. One is that the infection route of the two is the same. When there is sexual behavior, the high-risk individuals have the possibility of infecting Mg and HIV. Another point is Mg is a risk factor for the acquisition and spread of HIV or HIV infection increases the risk of host compromise for the Mg host. In 1990, Montagnier et al first discovered and reported that Mg may be involved in the infection and transmission of HIV. Later, some scholars have studied the correlation between them. In 2012, Mavedzenge et al. promoted the biological rationality of the acquisition and transmission of HIV from Mg. It is clear that HIV-infected women are more likely to shed HIV-DNA than those infected with Mg-negative cells. In 2014, in vitro experiments have shown that Mg infection can promote HIV infection; by 2015, Mg has It has been shown to be independently associated with HIV-1 RNA in the reproductive tract, but specific causal relationships and clear mechanisms of infection between Mg and HIV are still being studied. If Mg infection promotes the acquisition and transmission of HIV, then the detection and treatment of Mg will reduce the risk of HIV transmission and transmission, so it should be studied as soon as possible to understand the role of Mg in HIV transmission, which is very much in the prevention and control of AIDS. important.
To date, only the pathogenicity of Mg has been identified in a few diseases. Most of the diseases involved are related to Mg sensation, but there is still no definitive laboratory evidence and evidence of large sample epidemiology, which means Scholars need further research, and clinically urgently need a simple, rapid and accurate detection method, when patients have relevant clinical symptoms, can be applied to confirm the diagnosis and follow-up treatment, while controlling Mg infection The rising trend of the rate and the prevention of the emergence of drug-resistant strains due to drug abuse are of great significance.