Correlation between Mycoplasma Genitalium and HIV Infection: A Meta-Analysis_Chinese Journal of Evidence-Based Medicine

Authors：

ZHU Yi , WU Jianru , ZHANG Yu ,  WANG Bei

Key Laboratory of Environmental Medicine Engineering, Ministry of Education, School of Public Health, Southeast University, Nanjing 210009, China;

Corresponding author：

WANG Bei, Email: wangbeilxb@seu.edu.cn

Keywords：

HIV; Mycoplasma genitalium; Meta-analysis

DOI：

10.7507/1672-2531.20120206

Video：

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Objective 　To evaluate the correlation between mycoplasma genitalium and HIV infection.
Methods 　Databases including MEDLINE, ScienceDirect, EMbase, WanFang Data, and CNKI were searched from inception to March 2012, so as to identify the independent cohort studies, case-control studies and cross-sectional studies. Moreover, the references of relevant studies were also retrieved. According to the inclusion and exclusion criteria, the studies were screened, the data were extracted, and the methodological quality of the included studies was assessed. Then meta-analysis was performed using RevMan 4.2 and SAS 9.1.3 softwares.
Results 　A total of 19 studies were included, including 3 430 HIV infected patients and 7 656 controlled participants. The results of meta-analyses showed that the HIV infection group was more likely to infect mycoplasma genitalium than the control group (OR=2.34, 95%CI 1.68 to 3.28, P lt;0.000 01). The same results were found in both subgroup and sensitivity analyses.
Conclusion 　Mycoplasma genitaliuman infection is closely related to HIV infection. However, detailed pathogenesis is still unknown. Due to the limited quality and quantity of the included studies, more high-quality studies are needed to prove the above.

Citation： ZHU Yi,WU Jianru,ZHANG Yu,WANG Bei. Correlation between Mycoplasma Genitalium and HIV Infection: A Meta-Analysis. Chinese Journal of Evidence-Based Medicine, 2012, 12(11): 1314-1319. doi: 10.7507/1672-2531.20120206 Copy

1.	Risbud A, Chan-Tack K, Gadkari D, et al. The etiology of genital ulcer disease by multiplex polymerase chain reaction and relationship to HIV infection among patients attending sexually transmitted disease clinics in Pune, India. Sex Transm Dis, 1999, 26(1): 55-62.
2.	Plummer FA, Simonsen JN, Cameron DW, et al. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis, 1991, 163(2): 233-239.
3.	Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis and pelvic inflammatory disease. J Clin Pathol, 2003, 56(8): 616-618.
4.	Korte JE, Baseman JB, Cagle MP, et al. Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium. Am J Reprod Immunol, 2006, 55(4): 265-275.
5.	Wells GA, O’Connell D, Peterson J, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses. Ottawa Health Research Institute. www.ohri.ca/programs/clinical_epidemiology/oxford.asp. (accessed Oct 20, 2011).
6.	Cohen CR, Manhart LE, Bukusi EA, et al. Association between Mycoplasma genitalium and acute endometritis. Lancet, 2002, 359(9308): 765-766.
7.	Manhas A, Sethi S, Sharma M, et al. Association of genital mycoplasmas including Mycoplasma genitalium in HIV infected men with nongonococcal urethritis attending STD & HIV clinics. Indian J Med Res, 2009, 129(3): 305-310.
8.	Paz-Bailey G, Rahman M, Chen C, et al. Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. Clin Infect Dis, 2005, 41(9): 1304-1312.
9.	Ballard RC, Fehler HG, Htun Y, et al. Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management. Sex Transm Infect, 2002, 78(4): 274-277.
10.	Savio ML, Caruso A, Allegri R, et al. Detection of Mycoplasma genitalium from urethral swabs of human immunodeficiency virus-infected patients. New Microbiol, 1996, 19(3): 203-209.
11.	Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect, 2005, 81(6): 463-466.
12.	Mhlongo S, Magooa P, Muller EE, et al. Etiology and STI/HIV coinfections among patients with urethral and vaginal discharge syndromes in South Africa. Sex Transm Dis, 2010, 37(9): 566-570.
13.	Perez G, Skurnick JH, Denny TN, et al. Herpes simplex type II and Mycoplasma genitalium as risk factors for heterosexual HIV transmission: report from the heterosexual HIV transmission study. Int J Infect Dis, 1998, 3(1): 5-11.
14.	Mansson F, Camara C, Biai A, et al. High prevalence of HIV-1, HIV-2 and other sexually transmitted infections among women attending two sexual health clinics in Bissau, Guinea-Bissau, West Africa. Int J STD AIDS, 2010, 21(9): 631-635.
15.	Cordova CM, Blanchard A, Cunha RA. Higher prevalence of urogenital mycoplasmas in human immunodeficiency virus-positive patients as compared to patients with other sexually transmitted diseases. J Clin Lab Anal, 2000, 14(5): 246-253.
16.	Martinelli F, Garrafa E, Turano A, et al. Increased frequency of detection of Ureaplasma urealyticum and Mycoplasma genitalium in AIDS patients without urethral symptoms. J Clin Microbiol, 1999, 37(6): 2042-2044.
17.	Wang RY, Grandinetti T, Shih JW, et al. Mycoplasma genitalium infection and host antibody immune response in patients infected by HIV, patients attending STD clinics and in healthy blood donors. FEMS Immunol Med Microbiol, 1997, 19(3): 237-245.
18.	Lusk MJ, Konecny P, Naing ZW, et al. Mycoplasma genitalium is associated with cervicitis and HIV infection in an urban Australian STI clinic population. Sex Transm Infect, 2011, 87(2): 107-109.
19.	Labbe AC, Frost E, Deslandes S, et al. Mycoplasma genitalium is not associated with adverse outcomes of pregnancy in Guinea-Bissau. Sex Transm Infect, 2002, 78(4): 289-291.
20.	Pepin J, Labbe AC, Khonde N, et al. Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers. Sex Transm Infect, 2005, 81(1): 67-72.
21.	Vandepitte J, Muller E, Bukenya J, et al. Prevalence and Correlates of Mycoplasma genitalium Infection Among Female Sex Workers in Kampala, Uganda. J Infect Dis, 2012, 205(2): 289-296.
22.	Kapiga SH, Sam NE, Mlay J, et al. The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study. AIDS Care, 2006, 18(4): 379-387.
23.	Soni S, Alexander S, Verlander N, et al. The prevalence of urethral and rectal Mycoplasma genitalium and its associations in men who have sex with men attending a genitourinary medicine clinic. Sex Transm Infect, 2010, 86(1): 21-24.
24.	郭海健. 性病患者及其高危人群支原体感染的流行病学研究. 南京: 东南大学, 2007.
25.	Cohen CR, Nosek M, Meier A, et al. Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya. Sex Transm Dis, 2007, 34(5): 274-279.
26.	Blanchard A, Olson LD, Barile MF. Sexually transmitted mycoplasmas in humans. Mol Cell Biol Hum Dis Ser, 1992, 1: 55-83.
27.	Sasaki Y, Honda M, Makino M, et al. Mycoplasmas stimulate replication of human immunodeficiency virus type 1 through selective activation of CD4+ T lymphocytes. AIDS Res Hum Retroviruses, 1993, 9(8): 775-780.
28.	Phillips DM, Pearce-Pratt R, Tan X, et al. Association of mycoplasma with HIV-1 and HTLV-I in human T lymphocytes. AIDS Res Hum Retroviruses, 1992, 8(11): 1863-1868.
29.	McGowin CL, Popov VL, Pyles RB. Intracellular Mycoplasma genitalium infection of human vaginal and cervical epithelial cells elicits distinct patterns of inflammatory cytokine secretion and provides a possible survival niche against macrophage-mediated killing. BMC Microbiol, 2009, 9: 139.
30.	Manhart LE, Mostad SB, Baeten JM, et al. High Mycoplasma genitalium organism burden is associated with shedding of HIV-1 DNA from the cervix. J Infect Dis, 2008, 197(5): 733-736.
31.	Al-Harthi L, Kovacs A, Coombs RW, et al. A menstrual cycle pattern for cytokine levels exists in HIV-positive women: implication for HIV vaginal and plasma shedding. AIDS, 2001, 15(12): 1535-1543.

1. Risbud A, Chan-Tack K, Gadkari D, et al. The etiology of genital ulcer disease by multiplex polymerase chain reaction and relationship to HIV infection among patients attending sexually transmitted disease clinics in Pune, India. Sex Transm Dis, 1999, 26(1): 55-62.
2. Plummer FA, Simonsen JN, Cameron DW, et al. Cofactors in male-female sexual transmission of human immunodeficiency virus type 1. J Infect Dis, 1991, 163(2): 233-239.
3. Simms I, Eastick K, Mallinson H, et al. Associations between Mycoplasma genitalium, Chlamydia trachomatis and pelvic inflammatory disease. J Clin Pathol, 2003, 56(8): 616-618.
4. Korte JE, Baseman JB, Cagle MP, et al. Cervicitis and genitourinary symptoms in women culture positive for Mycoplasma genitalium. Am J Reprod Immunol, 2006, 55(4): 265-275.
5. Wells GA, O’Connell D, Peterson J, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses. Ottawa Health Research Institute. www.ohri.ca/programs/clinical_epidemiology/oxford.asp. (accessed Oct 20, 2011).
6. Cohen CR, Manhart LE, Bukusi EA, et al. Association between Mycoplasma genitalium and acute endometritis. Lancet, 2002, 359(9308): 765-766.
7. Manhas A, Sethi S, Sharma M, et al. Association of genital mycoplasmas including Mycoplasma genitalium in HIV infected men with nongonococcal urethritis attending STD & HIV clinics. Indian J Med Res, 2009, 129(3): 305-310.
8. Paz-Bailey G, Rahman M, Chen C, et al. Changes in the etiology of sexually transmitted diseases in Botswana between 1993 and 2002: implications for the clinical management of genital ulcer disease. Clin Infect Dis, 2005, 41(9): 1304-1312.
9. Ballard RC, Fehler HG, Htun Y, et al. Coexistence of urethritis with genital ulcer disease in South Africa: influence on provision of syndromic management. Sex Transm Infect, 2002, 78(4): 274-277.
10. Savio ML, Caruso A, Allegri R, et al. Detection of Mycoplasma genitalium from urethral swabs of human immunodeficiency virus-infected patients. New Microbiol, 1996, 19(3): 203-209.
11. Cohen CR, Mugo NR, Astete SG, et al. Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis. Sex Transm Infect, 2005, 81(6): 463-466.
12. Mhlongo S, Magooa P, Muller EE, et al. Etiology and STI/HIV coinfections among patients with urethral and vaginal discharge syndromes in South Africa. Sex Transm Dis, 2010, 37(9): 566-570.
13. Perez G, Skurnick JH, Denny TN, et al. Herpes simplex type II and Mycoplasma genitalium as risk factors for heterosexual HIV transmission: report from the heterosexual HIV transmission study. Int J Infect Dis, 1998, 3(1): 5-11.
14. Mansson F, Camara C, Biai A, et al. High prevalence of HIV-1, HIV-2 and other sexually transmitted infections among women attending two sexual health clinics in Bissau, Guinea-Bissau, West Africa. Int J STD AIDS, 2010, 21(9): 631-635.
15. Cordova CM, Blanchard A, Cunha RA. Higher prevalence of urogenital mycoplasmas in human immunodeficiency virus-positive patients as compared to patients with other sexually transmitted diseases. J Clin Lab Anal, 2000, 14(5): 246-253.
16. Martinelli F, Garrafa E, Turano A, et al. Increased frequency of detection of Ureaplasma urealyticum and Mycoplasma genitalium in AIDS patients without urethral symptoms. J Clin Microbiol, 1999, 37(6): 2042-2044.
17. Wang RY, Grandinetti T, Shih JW, et al. Mycoplasma genitalium infection and host antibody immune response in patients infected by HIV, patients attending STD clinics and in healthy blood donors. FEMS Immunol Med Microbiol, 1997, 19(3): 237-245.
18. Lusk MJ, Konecny P, Naing ZW, et al. Mycoplasma genitalium is associated with cervicitis and HIV infection in an urban Australian STI clinic population. Sex Transm Infect, 2011, 87(2): 107-109.
19. Labbe AC, Frost E, Deslandes S, et al. Mycoplasma genitalium is not associated with adverse outcomes of pregnancy in Guinea-Bissau. Sex Transm Infect, 2002, 78(4): 289-291.
20. Pepin J, Labbe AC, Khonde N, et al. Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers. Sex Transm Infect, 2005, 81(1): 67-72.
21. Vandepitte J, Muller E, Bukenya J, et al. Prevalence and Correlates of Mycoplasma genitalium Infection Among Female Sex Workers in Kampala, Uganda. J Infect Dis, 2012, 205(2): 289-296.
22. Kapiga SH, Sam NE, Mlay J, et al. The epidemiology of HIV-1 infection in northern Tanzania: results from a community-based study. AIDS Care, 2006, 18(4): 379-387.
23. Soni S, Alexander S, Verlander N, et al. The prevalence of urethral and rectal Mycoplasma genitalium and its associations in men who have sex with men attending a genitourinary medicine clinic. Sex Transm Infect, 2010, 86(1): 21-24.
24. 郭海健. 性病患者及其高危人群支原体感染的流行病学研究. 南京: 东南大学, 2007.
25. Cohen CR, Nosek M, Meier A, et al. Mycoplasma genitalium infection and persistence in a cohort of female sex workers in Nairobi, Kenya. Sex Transm Dis, 2007, 34(5): 274-279.
26. Blanchard A, Olson LD, Barile MF. Sexually transmitted mycoplasmas in humans. Mol Cell Biol Hum Dis Ser, 1992, 1: 55-83.
27. Sasaki Y, Honda M, Makino M, et al. Mycoplasmas stimulate replication of human immunodeficiency virus type 1 through selective activation of CD4+ T lymphocytes. AIDS Res Hum Retroviruses, 1993, 9(8): 775-780.
28. Phillips DM, Pearce-Pratt R, Tan X, et al. Association of mycoplasma with HIV-1 and HTLV-I in human T lymphocytes. AIDS Res Hum Retroviruses, 1992, 8(11): 1863-1868.
29. McGowin CL, Popov VL, Pyles RB. Intracellular Mycoplasma genitalium infection of human vaginal and cervical epithelial cells elicits distinct patterns of inflammatory cytokine secretion and provides a possible survival niche against macrophage-mediated killing. BMC Microbiol, 2009, 9: 139.
30. Manhart LE, Mostad SB, Baeten JM, et al. High Mycoplasma genitalium organism burden is associated with shedding of HIV-1 DNA from the cervix. J Infect Dis, 2008, 197(5): 733-736.
31. Al-Harthi L, Kovacs A, Coombs RW, et al. A menstrual cycle pattern for cytokine levels exists in HIV-positive women: implication for HIV vaginal and plasma shedding. AIDS, 2001, 15(12): 1535-1543.

Chinese Journal of Evidence-Based Medicine

Correlation between Mycoplasma Genitalium and HIV Infection: A Meta-Analysis

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