title: Apparently-Different Clearance Rates from Cohort Studies of Mycoplasma genitalium Are Consistent after Accounting for Incidence of Infection, Recurrent Infection, and Study Design.
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 0.80 p.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 3.44 p.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.
authors.affiliation: NIHR Health Protection Research Unit in Modelling Methodology and MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, United Kingdom.|Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, United Kingdom.
authors.forename: Timo
authors.initials: T
authors.lastname: Smieszek
authors.affiliation: NIHR Health Protection Research Unit in Modelling Methodology and MRC Centre for Outbreak Analysis and Modelling, Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London W2 1PG, United Kingdom.|Modelling and Economics Unit, Centre for Infectious Disease Surveillance and Control, Public Health England, London NW9 5EQ, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: White
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009175:Mycoplasma Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D045704:Mycoplasma genitalium; D060386:Sex Workers; D012749:Sexually Transmitted Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission; D014454:Uganda / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents