Apparently-Different Clearance Rates from Cohort Studies of Mycoplasma genitalium Are Consistent after Accounting for Incidence of Infection, Recurrent Infection, and Study Design.
File(s)
Published version
Author(s)
Smieszek, T
White, PJ
Type
Journal Article
Abstract
Mycoplasma genitalium is a potentially major cause of urethritis, cervicitis, pelvic inflammatory disease, infertility, and increased HIV risk. A better understanding of its natural history is crucial to informing control policy. Two extensive cohort studies (students in London, UK; Ugandan sex workers) suggest very different clearance rates; we aimed to understand the reasons and obtain improved estimates by making maximal use of the data from the studies. As M. genitalium is a sexually-transmitted infectious disease, we developed a model for time-to-event analysis that incorporates the processes of (re)infection and clearance, and fitted to data from the two cohort studies to estimate incidence and clearance rates under different scenarios of sexual partnership dynamics and study design (including sample handling and associated test sensitivity). In the London students, the estimated clearance rate is 0.80p.a. (mean duration 15 months), with incidence 1.31%-3.93%p.a. Without adjusting for study design, corresponding estimates from the Ugandan data are 3.44p.a. (mean duration 3.5 months) and 58%p.a. Apparent differences in clearance rates are probably mostly due to lower testing sensitivity in the Uganda study due to differences in sample handling, with 'true' clearance rates being similar, and adjusted incidence in Uganda being 28%p.a. Some differences are perhaps due to the sex workers having more-frequent antibiotic treatment, whilst reinfection within ongoing sexual partnerships might have caused some of the apparently-persistent infection in the London students. More information on partnership dynamics would inform more accurate estimates of natural-history parameters. Detailed studies in men are also required.
Date Issued
2016-02-24
Date Acceptance
2016-01-27
Citation
PLOS One, 2016, 11 (2)
ISSN
1932-6203
Publisher
Public Library of Science
Journal / Book Title
PLOS One
Volume
11
Issue
2
Copyright Statement
© 2016 Crown copyright. Reproduced
with the permission of the Controller of Her Majesty’s
Stationery Office/Queen’s Printer for Scotland and
Public Health England. The Open Government
License used by Crown Copyright permits anyone to
copy, publish, distribute, transmit and adapt this work
for commercial and/or non-commercial purposes,
with proper attribution. To view this licence, visit http://
www.nationalarchives.gov.uk/doc/open-governmentlicence/version/3..
with the permission of the Controller of Her Majesty’s
Stationery Office/Queen’s Printer for Scotland and
Public Health England. The Open Government
License used by Crown Copyright permits anyone to
copy, publish, distribute, transmit and adapt this work
for commercial and/or non-commercial purposes,
with proper attribution. To view this licence, visit http://
www.nationalarchives.gov.uk/doc/open-governmentlicence/version/3..
Identifier
PII: PONE-D-15-04045
Subjects
General Science & Technology
MD Multidisciplinary
Publication Status
Published
Article Number
e0149087