[Update on Mycoplasma genitalium among women]. / Le point sur Mycoplasma genitalium chez la femme.

Mycoplasma genitalium (MG) is a sexually transmitted pathogen with a poorly understood natural history. Often asymptomatic, it has been associated with urogenital conditions. The implementation of NAAT (Nucleic Acide Amplification Test) has not only improved the detection of MG, but also brought to light the emergence of antibiotic resistances, hence challenging the proposed treatment strategies and questioning the indication for systematic screening. This article summarizes current knowledge on MG among women, over viewing incidence, prevalence and clinical implications. It resumes the last guidelines in terms of screening and treatment.

Mycoplasma genitalium (MG) est un pathogène sexuellement transmissible souvent asymptomatique, dont la pathogénicité est méconnue. Source croissante d'intérêt car mieux détecté depuis l'implémentation des NAAT (Nucleic Acide Amplification Test), MG serait incriminé dans diverses pathologies uro-génitales. L'émergence des résistances aux antibiotiques est un enjeu de taille dans le traitement de l'infection et soulève le débat sur l'utilité d'un dépistage systématique. Cet article résume l'état des connaissances actuelles au sujet de MG chez la femme : son incidence, sa prévalence ainsi que ses implications cliniques. Il fait la synthèse des dernières recommandations en termes de dépistage et de traitement.

Cervical cancer screening in sub-Saharan Africa: a randomized trial of VIA versus cytology for triage of HPV-positive women.

Developing countries are interested in using human papillomavirus (HPV) testing as a primary screening test for cervical cancer prevention programs. The low specificity of the HPV assay requires triage testing of HPV-positive women. The aim of the study is to compare visual inspection with acetic acid (VIA) and cytology as triage testing methods in HPV-positive women to detect cervical intraepithelial neoplasia or Grade 2 or higher (CIN2+). The study was conducted in two Cameroonian towns (Yaoundé and Edea) and included 846 eligible women aged 25 to 65 years. All participants performed self-HPV testing. HPV-positive women (n = 259) were randomly assigned to be tested either by VIA (VIA group) or cytology (cytology group). HPV-positive women had both cervical biopsy and endocervical curettage to detect biopsy-confirmed CIN2+. All statistical tests were two-sided. The prevalence of HPV was 38.5%, and the mean age of HPV-positive women was 41.5 ± 10.1 years. One hundred ninety-eight women (97 in the VIA group and 99 in the cytology) were randomly assigned to one of the two testing arms. The sensitivity of VIA was 25.0% (95% CI, 7.1-59.1%), and the sensitivity of cytology was 90.0% (59.6-98.2%). The specificity was 74.2% (95% CI, 64.2-82.1%) for VIA and 85.2% (76.3-91.2%) for cytology. ROC area for cytology was 0.910 against the 0.496 area for VIA. In this trial, VIA was inferior to cytology as a triage test among HPV-positive women. Further investigations are needed to determine the optimal triage method for HPV-positive women.

High Burden of Human Papillomavirus Infection in Madagascar: Comparison With Other Sexually Transmitted Infections.

BACKGROUND: In Madagascar, human papillomavirus (HPV), human immunodeficiency virus (HIV), and hepatitis B virus (HBV) infection, as well as syphilis share common risk factors but seem to differ in their prevalence. We measured and compared their prevalence in the country. METHODS: The data used in this study came from the Saint Damien Health Centre in Ambanja, Madagascar. The tests used for disease detection were the Alere Determine, Virucheck, rapid plasma reagin, and S-DRY self-HPV samples for HIV infection, HBV infection, syphilis, and HPV infection, respectively. RESULTS: In men and women, respectively, the prevalence was 0.6% and 0.4% for HIV infection, 2.2% and 2.0% for HBV infection, and 0.6% and 0.3% for syphilis. The HPV infection prevalence was 39.3%. CONCLUSIONS: Despite common risk factors, the prevalence of HPV infection was high, in contrast to a much lower prevalence of other sexually transmitted infections (STIs) in the same geographical area. Further investigations are required to clarify the status of STIs in the Malagasy population.