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Sexually Transmitted Diseases:
doi: 10.1097/01.OLQ.0000431360.03712.1b
Letter to the Editor

Prevalence of Mycoplasma genitalium Among HIV-Infected Women, Agence Nationale de Recherches sur le SIDA et les hépatites virales CO3 Aquitaine Cohort, France

Cazanave, Charles MD, PhD; Lawson-Ayayi, Sylvie PharmD, PhD; Hessamfar, Mojgan MD, PhD; Neau, Didier MD, PhD; Dupon, Michel MD; Morlat, Philippe MD, PhD; Dabis, François MD, PhD; de Barbeyrac, Bertille PharmD, PhD; Bébéar, Cécile MD, PhD; Pereyre, Sabine PharmD, PhD

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Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Médecine Tropicale, Hôpital Pellegrin, Bordeaux, France

Univ. Bordeaux, USC EA 3671, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France

Institut National de la Recherche Agronomique, USC EA 3671, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France charles.cazanave@chu-bordeaux.fr

Univ. Bordeaux, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

INSERM, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, COREVIH d’Aquitaine, Bordeaux, France

Univ. Bordeaux, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

INSERM, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, COREVIH d’Aquitaine, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, Service des Maladies Infectieuses et Médecine Tropicale, Hôpital Pellegrin, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, COREVIH d’Aquitaine, Bordeaux, France

Univ. Bordeaux, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

INSERM, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, COREVIH d’Aquitaine, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, Service de Médecine Interne et Maladies Infectieuses, Hôpital Saint-André, Bordeaux, France

Univ. Bordeaux, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

INSERM, Institut de Santé Publique, Epidémiologie et Développement (ISPED), Centre INSERM U897-Epidémiologie-Biostatistique, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, COREVIH d’Aquitaine, Bordeaux, France

Univ. Bordeaux, USC EA 3671, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France

Institut National de la Recherche Agronomique, USC EA 3671, Infections humaines à mycoplasmes et à chlamydiae, Bordeaux, France

Centre Hospitalier Universitaire de Bordeaux, Laboratoire de Bactériologie, Bordeaux, France

Conflict of interest: None declared.

Acknowledgments: The Aquitaine Cohort is supported by the Agence Nationale de Recherches sur le SIDA et les hépatites virales (ANRS), Grant ANRS CO3. This study was supported in part by a grant from the French National Reference Center for chlamydiae (French Institute for Public Health surveillance). The authors are grateful to Marie-Josée Blaizeau, Madeleine Decoin, Bellancille Uwamaliya-Nziyumvira, and Jean Delaune for their technical assistance and to all the Groupe d’Epidémiologie Clinique du SIDA en Aquitaine members.

To the Editor:

Mycoplasma genitalium is an emerging sexually transmitted pathogen associated with inflammatory reproductive tract syndromes in women, including cervicitis and pelvic inflammatory disease.1 Several studies showed a strong association between M. genitalium and HIV infections, especially in African populations.2,3Recently, a cohort study reported a relationship between M. genitalium infection and risk of HIV-1 acquisition in African women.4 However, the prevalence of M. genitalium infection is poorly documented in HIV-positive (HIV+) women from high-income countries. Prevalence was evaluated at 9.9% in HIV+ women surveyed in the United States between 2002 and 2005,5 but little is known in Europe.

The objectives of this study were to estimate the prevalence and investigate the factors associated with M. genitalium infection in HIV+ women of the French Agence Nationale de Recherches sur le SIDA et les hépatites virales (ANRS) CO3 Aquitaine hospital-based cohort. Prevalence of Chlamydia trachomatis infection was also assessed.

The ANRS CO3 Aquitaine cohort includes 28% of HIV-1–infected women. Cohort female participants aged 18 to 50 years had to consent to the study. Those treated with macrolides, fluoroquinolones, or tetracyclines within the prior 5 weeks were noneligible. Clinical information was collected as well as sexual behaviors according to a standardized questionnaire. A self-collected vaginal swab was obtained from each woman. Detection of M. genitalium DNA was performed using an in-house real-time polymerase chain reaction6 and detection of C. trachomatis using the COBAS TaqMan CT Test (Roche Diagnostics).

A total of 105 women were included between October 2008 and June 2011, of whom 44 (41.9%) were nonwhite. The median age was 41.3 years (interquartile range, 34.1–44.5 years). The median follow-up since HIV diagnosis was 142.3 months (interquartile range, 71.6–212.3 months), and 92.4% of patients were treated with antiretroviral treatment. HIV RNA was undetectable in 79.8% of patients, and the median CD4 count was 544/mL. Chronic active hepatitis C (hepatitis C virus RNA positive) or hepatitis B (hepatitis B virus surface antigen positive) were documented in 32 patients.

Sexual behavior questionnaires highlight frequent use of condoms among HIV+ women of our cohort, and prevention messages seem to be accepted and respected (Table 1).

Table 1
Table 1
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The prevalence of M. genitalium infection was 3.8% (4/106; 95% confidence interval, 1.0–9.8). Specific sexual behaviors, HIV infection characteristic, and viral hepatitis coinfection were not significantly associated with M. genitalium infection. Among the 4 patients infected with M. genitalium, 3 were asymptomatic and 1 was diagnosed as having an endometritis. She was successfully treated with ofloxacin for 3 weeks. No C. trachomatis infection was detected.

The prevalence of M. genitalium infection seems lower among French HIV+ women in care than in the US population, but age and race distribution differed slightly (41.3 vs. 35.0 years and 42% of nonwhite vs. 84% of African Americans in the US study, respectively).5 This prevalence is similar to the 1% to 3% usually quoted in the general population from high-income countries.7,8 However, our sample size is limited, and further longitudinal studies are needed to better understand the burden of disease.

In conclusion, a systematic screening of HIV+ women for M. genitalium is unlikely to have a significant interest for the case management in France.

Charles Cazanave, MD, PhD

Centre Hospitalier

Universitaire de Bordeaux

Service des Maladies Infectieuses

et Médecine Tropicale

Hôpital Pellegrin

Bordeaux, France

Univ. Bordeaux

USC EA 3671

Infections humaines à

mycoplasmes et à chlamydiae

Bordeaux France

Institut National de la

Recherche Agronomique

USC EA 3671

Infections humaines à

mycoplasmes et à chlamydiae

Bordeaux, France

charles.cazanave@chu-bordeaux.fr

Sylvie Lawson-Ayayi, PharmD, PhD

Univ. Bordeaux

Institut de Santé Publique

Epidémiologie et Développement (ISPED)

Centre INSERM

897-Epidémiologie-Biostatistique

Bordeaux, France

INSERM

Institut de Santé Publique

Epidémiologie et Développement (ISPED)

Centre INSERM

U897-Epidémiologie-Biostatistique

Bordeaux, France

Centre Hospitalier Universitaire

de Bordeaux

COREVIH d’Aquitaine

Bordeaux, France

Mojgan Hessamfar, MD, PhD

Philippe Morlat, MD, PhD

Univ. Bordeaux

Institut de Santé Publique

Epidémiologie et Développement (ISPED)

Centre INSERM

U897-Epidémiologie-Biostatistique

Bordeaux, France

INSERM

Institut de Santé Publique

Epidémiologie et Développement (ISPED)

Centre INSERM

U897-Epidémiologie-Biostatistique

Bordeaux, France

Centre Hospitalier Universitaire

de Bordeaux

COREVIH d’Aquitaine

Bordeaux France

Centre Hospitalier Universitaire

de Bordeaux

Service de Médecine Interne

et Maladies Infectieuses

Hôpital Saint-André

Bordeaux, France

Didier Neau, MD, PhD

Michel Dupon, MD

Centre Hospitalier

Universitaire de Bordeaux

Service des Maladies Infectieuses

et Médecine Tropicale

Hôpital Pellegrin

Bordeaux, France

Centre Hospitalier Universitaire

de Bordeaux

COREVIH d’Aquitaine

Bordeaux, France

François Dabis, MD, PhD

Univ. Bordeaux

Institut de Santé Publique

Epidémiologie et Développement (ISPED)

Centre INSERM

U897-Epidémiologie-Biostatistique

Bordeaux, France

INSERM

Institut de Santé Publique

Epidémiologie et Développement (ISPED)

Centre INSERM

U897-Epidémiologie-Biostatistique

Bordeaux, France

Centre Hospitalier Universitaire

de Bordeaux

COREVIH d’Aquitaine

Bordeaux, France

Bertille de Barbeyrac, PharmD, PhD

Cécile Bébéar, MD, PhD

Sabine Pereyre, PharmD, PhD

Univ. Bordeaux

USC EA 3671

Infections humaines à

mycoplasmes et à chlamydiae

Bordeaux, France

Institut National de la

Recherche Agronomique

USC EA 3671

Infections humaines à

mycoplasmes et à chlamydiae

Bordeaux, France

Centre Hospitalier Universitaire

Centre Hospitalier Universitaire

de Bordeaux

Laboratoire de Bactériologie

Bordeaux, France

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REFERENCES

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