Little Known STD Causes Infertility, Is More Common Than Gonorrhea

by NCN Health And Science Team Posted on November 19th, 2018

Houston, Texas, USA : Johns Hopkins researchers are spearheading efforts to raise awareness and learn more about a sexually transmitted disease few people know about but scientists believe makes people infertile.

Many people infected with mycoplasma genitalium, or Mgen for short, don’t show symptoms and might not know they are carrying the disease. There’s no approved test for it, which makes it difficult to track, but doctors believe it’s more common than gonorrhea, infecting about 1 to 3 percent of the population.

While scientists have known about the bacterial infection since 1980, the U.S. Centers for Disease Control and Prevention officially acknowledged the disease only in 2015, including it for the first time in their assessment of STDs. But there is rising concern about the risk of the infection’s spread given the lack of symptoms and because some strains have been found to be resistant to antibiotics, limiting treatment options.

At the Johns Hopkins Bloomberg School of Public Health, researchers are conducting a trial on a test that can detect Mgen.

Dr. Maria Trent, a professor of pediatrics and public health at Johns Hopkins Medicine, got involved in the work through her interest in studying fertility preservation in high-risk youth. She’s also looked at the disease’s link to pelvic inflammatory disease and how prevalent the disease is in the general population.

“Our research really suggests that if nothing else, we should think carefully about how we might begin to incorporate testing for Mgen on a regular basis,” Trent said.

The test Trent is analyzing was developed by Australia-based SpeedX and is being used in Europe, the United Kingdom, Australia and New Zealand. Her research will help determine its effectiveness so it can get approval from the U.S. Food and Drug Administration for use here.

The test also checks for biomarkers linked to antibiotic resistance, so doctors can determine whether a patient needs something other than the common treatment, which is the antibiotic azithromycin.

“The diagnostic testing has not always been there until the advent of genetic testing,” SpeedX CEO Colin Denver said. “Now we can determine if there needs to be a second line of treatment.”

Clinical trials analyzing the test also are being conducted at the University of Alabama at Birmingham and TriCore Reference Laboratories in Albuquerque, N.M.

The Massachusetts-based company Hologic is seeking FDA approval for a different diagnostic test.

When people with Mgen do develop symptoms, they are often similar to those brought on by chlamydia and gonorrhea. Men can develop watery discharge from the penis and painful urination. Women might have vaginal discharge, pain during sex and bleeding after, and pain in the pelvic area.

Patients are often misdiagnosed and given antibiotics for other STDs rather than Mgen, mainly because doctors aren’t as familiar with the disease. The real disease might be left untreated.

Research has linked Mgen to infertility, but more large-scale studies need to be done to gather more conclusive evidence, researchers said.

Some studies have shown, for instance, that it can lead to urethritis—inflammation of the urethra, which carries urine from the bladder to the penis—in men, but the CDC said it is not yet clear enough whether it leads to male infertility.

The federal agency said the data are even less conclusive on women. The Mgen bacteria are found in the cervix or the uterus lining of women with pelvic inflammatory disease, a common cause of infertility, more often than women without it. How often women experience pelvic inflammatory disease has been understudied, the CDC said.

Some researchers believe women who develop multiple cases of pelvic inflammatory disease might have been treated for the wrong STD.

Studies also found that women with infertility caused by scarring of the fallopian tubes, which carry eggs from the ovaries to the uterus, also are more likely to have antibodies related to Mgen than fertile women, suggesting that this organism might cause female infertility, the CDC said.

However, more research is needed.

While Mgen is thought to affect only a small fraction of the population, the incidence increases for high-risk populations, such as young people with multiple partners, said Lisa Manhart, a professor of epidemiology and global health at the University of Washington who has studied Mgen for many years. It is believed to affect as much as 20 percent of that population, she said.

Because Mgen doesn’t show symptoms and there is not standardized test, people might be damaging their reproductive system without knowing it.

“With (Mgen) there is this vile inflammation that a woman isn’t aware of,” Manhart said. “But it is the inflammation that causes the damage that can cause the infertility.”

Other countries have been ahead of the curve with treating Mgen. This past summer, the British Association of Sexual Health and HIV published guidelines to better detect and treat the disease.

In the United States, tracking of the disease is spotty with most data coming from smaller research studies. Doctors aren’t required to report the disease to local health departments the way they are other STDs.

But the disease has been pushed more to the forefront in the United States in recent years as more research has been conducted on it, giving some scientists hope.

The CDC’s decision to designate Mgen as an STD—although the agency didn’t go as far as to recommend routine testing—will help bring more attention to the disease.

A routine test could help generate more data to better understand Mgen, researchers said.

“How can you talk about treating mycoplasma if you don’t have a way to test for it,” said Charlotte A. Gaydos, a professor in the division of infectious diseases at Johns Hopkins University School of Medicine, who is working on the research with Trent. “We have our fingers crossed that we get approval.”

2.5 million U.S. women have condition that can cause infertility

About 2.5 million American women have had pelvic inflammatory disease, an often-symptomless infection of the reproductive tract that can cause infertility and lasting abdominal pain, a new U.S. government report shows

Scientists also found that those who had 10 or more male sex partners experienced pelvic inflammatory disease three times as often as women with a single partner.

The culprits in most cases of pelvic inflammatory disease, or PID, are the sexually transmitted diseases (STDs) chlamydia and gonorrhea, researchers said. Overall, about 4.4 percent of American women said they’d been diagnosed with PID.

Pelvic inflammatory disease tends to be a later “complication of having a prior sexually transmitted infection, and given that there are such high numbers of chlamydia and gonorrhea infections in the U.S., it means a lot of women are at risk,” said study author Kristen Kreisel. She’s an epidemiologist with the Division of STD Prevention at the U.S. Centers for Disease Control and Prevention.

“Pelvic inflammatory disease can be treated, as well as the STD that caused it, but the structural damage that occurs because of PID is often irreversible,” Kreisel said. “That’s why it’s important to stay on top of it.”

Chlamydia and gonorrhea are the most commonly reported STDs in the United States. About 1.5 million chlamydia and 400,000 gonorrhea infections were reported in 2015. These infections often don’t cause symptoms and may go undiagnosed and untreated, according to the study.

When symptoms do appear, they may include abnormal vaginal discharge or a burning sensation during urination.

Pelvic inflammatory disease symptoms may include persistent abdominal pain, fever, abnormal vaginal discharge, or pain or bleeding during sexual intercourse, Kreisel said.

PID poses long-term hazards such as infertility, chronic pelvic pain and ectopic pregnancy. Ectopic pregnancies occur when an embryo implants in the fallopian tube instead of the uterus.

No single test can diagnose PID, so doctors often rely on symptom reporting. But PID often doesn’t cause symptoms, Kreisel explained. “That’s one of the scariest things because you may not know it’s even happening,” she said.

The researchers used information from the U.S. National Health and Nutrition Examination Survey from 2013 to 2014. This survey included nearly 1,200 women between the ages of 18 and 44.

The study didn’t find any significant differences in PID prevalence by age, race, ethnicity or socioeconomic factors.

Pelvic inflammatory disease prevalence, however, was significantly higher among women whose sexual behaviors placed them at greater risk for contracting STDs. These behaviors included having sex with multiple partners and not using condoms.

Dr. Matthew Hoffman is chair of obstetrics and gynecology at Christiana Care Health System in Wilmington, Del.

Hoffman said that, in addition to using condoms, progesterone-containing birth control pills or intrauterine devices (IUDs) can also help reduce the risk of developing pelvic inflammatory disease. He wasn’t involved in the study.

Hoffman explained that progesterone-containing birth control pills or IUDs can help thicken cervical mucus, hindering bacteria from moving further into the reproductive tract.

Kreisel and Hoffman agreed that sexually active women under age 25 should be screened annually for STDs. That process usually involves a vaginal swab or a urine test. Treatment for gonorrhea and chlamydia typically includes antibiotics.

“There’s some data that if symptoms are treated early, it may result in better fertility outcomes,” Hoffman added.

The study findings was published in the CDC’s Morbidity and Mortality Weekly Report.

Citation for CDC study: Kristen Kreisel, Ph.D., epidemiologist, Division of STD Prevention, U.S. Centers for Disease Control and Prevention, Atlanta; Matthew Hoffman, M.D., M.P.H., Marie E. Pinizzotto, M.D., Endowed Chair of Obstetrics and Gynecology, Christiana Care Health System, Wilmington, Del.; Morbidity and Mortality Weekly Report

Screen women for chlamydia, gonorrhea, experts say

All sexually active women should be screened for two of the most common sexually transmitted infections: chlamydia and gonorrhea, according to new recommendations from the U.S. Preventive Services Task Force.

The task force noted this recommendation includes older women, those younger than 24 years of age and pregnant women.

Most women with chlamydia and gonorrhea don’t develop noticeable symptoms. As a result, many infections go undetected. If left untreated, these sexually transmitted infections can cause serious complications for both women and unborn babies.

Although chlamydia and gonorrhea are most common among young women, older women who engage in risky sexual behaviors—such as having multiple partners and not using condoms—are also at risk, said a news release from the American College of Physicians.

If women develop new risk factors for these sexually transmitted infections since their last negative test result, they should be screened again, according to the recommendations published on Monday in Annals of Internal Medicine.

Pregnant women who test positive for chlamydia or gonorrhea in the first trimester should be re-tested three months after being treated.

The are no significant risks associated with screening for chlamydia and gonorrhea. The task force noted there was not enough evidence to provide recommendations on chlamydia and gonorrhea screening for men.

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