Mycoplasma genitalium e demais Mollicutes
uma revisão de escopo
Palavras-chave:
Mollicutes, Mycoplasma genitalium, AntibióticosResumo
No contexto das infecções genitais, destaca-se a importância das bactérias Mycoplasma genitalium (MG), Mycoplasma Hominis (MH) e Ureaplasma spp., pertencentes à classe Mollicutes. Esses microrganismos podem causar infecções sexualmente transmitidas (ISTs) e estar relacionados a problemas durante a gravidez, vaginoses bacterianas, doença inflamatória pélvica e infertilidade. Nesse sentido, é crucial avançar cientificamente para compreender as demandas necessárias relacionadas ao tratamento e rastreamento, temas abordados nesta revisão narrativa a partir de cinco questões norteadoras da prática clínica. Em linhas gerais, o M. genitalium é destacado como um agente de impacto, embora não haja consenso exato sobre sua etiopatogenia e conduta. A incidência e resistência a ele são notórias e estão em preocupante ascensão. Discute-se a possível associação da resistência com o tratamento rotineiro de cervicites utilizando azitromicina em dose única. Propõem- se esquemas de tratamento adaptados a essas situações, como o modelo estendido ou sequencial.
Referências
Fathizadeh Z, Tehrani HG, Kazemi M, Karbasizade V. Rapid detection and simultaneous identification of the Mycoplasma and Ureaplasma species by real-time PCR and melt curve analysis among fertile and infertile females. Iran J Basic Med Sci. 2023;26(6):628–34.
Lucena Nemirosky J, Espelt R, López Grado E, Sobrino J, Acera A, Pérez J, et al. Macrolide resistance in Mycoplasma genitalium in Catalonia, Spain: A 1 year prospective study. J Antimicrob Chemother. 2021;76(10):2702–7.
Hong X, Zhao J, Ding X, Yin J, Ma X, Wang B. A preliminary study on the associations between Ureaplasma, Mycoplasma and the vaginal microbiome. Med Microecol. 2021;8(August).
Demirel E, McNally ST, Shan W, Goldberg GL. Prevalence of mycoplasma/ureaplasma infections in women presenting with recurrent vaginitis in the ambulatory setting. J Reprod Med. 2021;66(1–2):3–8.
Piscopo RCCP, Guimarães R V., Ueno J, Ikeda F, Bella ZIKJ Di, Girão MJBC, et al. Increased prevalence of endocervical mycoplasma and ureaplasma colonization in infertile women with tubal factor. J Bras Reprod Assist. 2020;24(2):152–7.
Alinezhad S, Bakhshandehnosrat S, Baniaghil AS, Livani S, Bazouri M, Shafipour M, et al. The Role of Genital Mycoplasmas in Preterm Labor. J Reprod Infertil. 2022;23(2):114–9.
Teixeira Oliveira CN, Oliveira MTS, Martins Oliveira HB, Coelho Silva LS, Santos Júnior MN, Almeida CF, et al. Ureaplasma parvum alters the immune tolerogenic state in placental tissue and could cause miscarriage. Fertil Steril. 2021;116(4):1030–9.
Gallini F, De Rose DU, Coppola M, Pelosi MS, Cota F, Bottoni A, et al. Maternal Ureaplasma/Mycoplasma colonization during pregnancy and neurodevelopmental outcomes for preterm infants. Front Pediatr. 2022;10(August):1–9.
Brin C, Palich R, Godefroy N, Simon A, Robert J, Bébéar C, et al. Clinical, epidemiological and therapeutic characteristics of Mycoplasma genitalium infection in a French STI center. Infect Dis Now. 2022;52(1):13–7.
Wang Y, Zhang B, Sun Y, Liu Y, Gu Y. Loop-mediated isothermal amplification on crude DNA as a point-of-care test for the diagnosis of mycoplasma-related vaginitis during early pregnancy. Lab Med. 2018;49(1):59–67.
Hetem DJ, Kuizenga Wessel S, Bruisten SM, Braam JF, van Rooijen MS, Vergunst CE, et al. High prevalence and resistance rates of Mycoplasma genitalium among patients visiting two sexually transmitted infection clinics in the Netherlands. Int J STD AIDS. 2021;32(9):837–44.
Yusuf E, Mertens K, Van Lisdonk N, Houwen C, Thai KTD. Epidemiology of Mycoplasma genitalium and Trichomonas vaginalis in the primary health care setting in the Netherlands. Epidemiol Infect. 2023;151(e79):1–4.
Zhang Z, Zong X, Bai H, Fan L, Li T, Liu Z. Prevalence of Mycoplasma genitalium and Chlamydia trachomatis in Chinese female with lower reproductive tract infection: a multicenter epidemiological survey. BMC Infect Dis. 2023;23(2):1–11.
Amorim AL, Travassos AGÁ, Souza GC de, Fontes VC, Timbó M, Souza EX. Prevalence of ureaplasma urealyticum, mycoplasma hominis and human papillomavirus coinfection in people attending a sexually transmitted infections (STI)/HIV reference centre in Salvador, Bahia, Brazil. J Bras Doenças Sex Transm. 2020;31(4):131–7.
Menezes ME, Silver EJ, Goldstein DY, Collins-Ogle MD, Fox AS, Coupey SM. Prevalence and Factors Associated With Mycoplasma genitalium Infection in At-Risk Female Adolescents in Bronx County, New York. Sex Transm Dis. 2023;50(10):635–41.
Lewis J, Horner PJ, White PJ. Incidence of pelvic inflammatory disease associated with mycoplasma genitalium infection: Evidence synthesis of cohort study data. Clin Infect Dis. 2020;71(10):2719–22.
Seña AC, Lee JY, Schwebke J, Philip SS, Wiesenfeld HC, Rompalo AM, et al. A silent epidemic: The prevalence, incidence and persistence of mycoplasma genitalium among young, asymptomatic high-risk women in the United States. Clin Infect Dis. 2018;67(1):73–9.
Santos NC de S, Scodro RB de L, de Andrade VT, Siqueira VLD, Caleffi-Ferracioli KR, de Pádua RAF, et al. Occurrence of Mycoplasma spp. and Ureaplasma spp. in genital specimens. Acta Sci - Heal Sci. 2020;42(1):1–6.
Ke W, Li D, Tso LS, Wei R, Lan Y, Chen Z, et al. Macrolide and fluoroquinolone associated mutations in Mycoplasma genitalium in a retrospective study of male and female patients seeking care at a STI Clinic in Guangzhou, China, 2016-2018. BMC Infect Dis. 2020;20(950):1–8.
Sweeney EL, Lowry K, Bletchly C, Nimmo GR, Whiley DM. Mycoplasma genitalium infections can comprise a mixture of both fluoroquinolone-susceptible and fluoroquinolone-resistant strains. J Antimicrob Chemother. 2021;76(4):887–92.
Conway RJH, Cook S, Malone C, Bone S, Hassan-Ibrahim MO, Soni S. Clearance of Mycoplasma genitalium Infection with Moxifloxacin in the Presence of Quinolone Resistance-Associated Mutations. Sex Transm Dis. 2020;47(3):197–8.
CDC. Sexually Transmitted Infection Treatment Guidelines [Internet]. Centers for Disease Control and Prevention. 2021 [cited 2023 Jun 11]. Available from: https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm
Hilmarsdóttir I, Arnardóttir EM, Jóhannesdóttir ER, Valsdóttir F, Golparian D, Hadad R, et al. Prevalence of Mycoplasma genitalium and Antibiotic Resistance-Associated Mutations in Patients at a Sexually Transmitted Infection Clinic in Iceland, and Comparison of the
S-DiaMGTV and Aptima Mycoplasma genitalium Assays for Diagnosis. Munson E, editor. J Clin Microbiol [Internet]. 2020 Aug 24;58(9):1–7. Available from: https://journals.asm.org/doi/10.1128/JCM.01084-20
Allan-Blitz LT, Mokany E, Campeau S, Wee R, Shannon C, Klausner JD. Prevalence of Mycoplasma genitalium and Azithromycin-resistant Infections among Remnant Clinical Specimens, Los Angeles. Sex Transm Dis. 2018;45(9):632–5.
Mondeja BA, Couri J, Rodríguez NM, Blanco O, Fernández C, Jensen JS. Macrolide-resistant Mycoplasma genitalium infections in Cuban patients: An underestimated health problem. BMC Infect Dis. 2018;18(601):1–6.
Clarke EJ, Vodstrcil LA, Plummer EL, Aguirre I, Samra RS, Fairley CK, et al. Efficacy of Minocycline for the Treatment of Mycoplasma genitalium. Open Forum Infect Dis [Internet]. 2023;10(8):1–7. Available from: https://doi.org/10.1093/ofid/ofad427
Gu X, Liu S, Guo X, Weng R, Zhong Z. Epidemiological investigation and antimicrobial susceptibility analysis of mycoplasma in patients with genital manifestations. J Clin Lab Anal. 2020;34(4).
Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de DST A e HV. Protocolo Clínico e Diretrizes Terapêuticas (PCDT). Atenção Integral ás pessoas com infecções sexualmente tranmissíveis (IST) 2020 [Internet]. Protocolo Clínico e
Diretrizes Terapêuticas (PCDT) - Atenção Integral às pessoas com infecções sexualmente transmissíveis. 2020. 1–121 p. Available from: www.saude.gov.br/bvs
Nolskog P, Backhaus E, Nasic S, Enroth H. STI with Mycoplasma genitalium—more common than Chlamydia trachomatis in patients attending youth clinics in Sweden. Eur J Clin Microbiol Infect Dis. 2019;38(1):81–6.
