Showing posts with label STI. Show all posts
Showing posts with label STI. Show all posts

Monday, February 4, 2019

FDA approves first ever diagnostic test for Mycoplasma genitalium


The US Food and Drug Administration (FDA) approved the first-ever diagnostic test to aid in the diagnosis of sexually transmitted Mycoplasma genitalium infection. The Aptima Assay from Hologic Inc, is the only FDA-approved test to detect this under-recognized but increasingly common sexually transmitted infection (STI).

First discovered in the early 1980s, M. genitalium was listed as an emerging public health threat by the U.S. Centers for Disease Control and Prevention (CDC) in 2015. Currently, it is responsible for causing approximately 15 to 30 percent of persistent or recurrent urethritis cases in men in the United States and 10 to 30 percent of cervicitis cases in women.

This slow-growing pathogen is difficult to detect by traditional laboratory testing methods. In the absence of FDA approved diagnostic test, the STI is often misdiagnosed and treated with wrong antibiotics resulting in persisting infection and widespread transmission.



“Although Mycoplasma genitalium is typically more common than gonorrhea, there is very little public awareness of this rising sexually transmitted infection, which can cause serious and potentially devastating health problems,” said Damon Getman, Ph.D., senior principal research scientist and director of research at Hologic in a press release.

The Aptima Assay is a nucleic acid amplification test, which detects M. genitalium in urine samples and urethral, penile meatal, endocervical or vaginal swab collected in a clinical setting, such as a doctor’s office or clinic.

In the clinical study involving 11,774 samples, the Aptima test correctly identified M. gen. in approximately 90 percent of vaginal, male urethral, male urine and penile samples. It also correctly identified the presence of the pathogen in female urine and endocervical samples 77.8 percent and 81.5 percent of the time.

The test also has a high negative predictive value and correctly identified the negative samples 97.8 to 99.6 percent of the time. Vaginal swabs are the preferred samples to perform the test, but urine samples can be used as alternative sample types.

The assay is immediately available at clinical laboratories, physicians and healthcare providers can immediately order the tests by reaching out to the labs. Hologic further anticipates that most insurance plans will cover the testing for M. genitalium.

The Aptima Mycoplasma genitalium Assay was reviewed through the de novo premarket pathway, a regulatory pathway for some low- to moderate-risk devices of a new type.  The FDA exercises special controls over the individual tests approved by the de novo premarket route to ensure the safety and effectiveness of the tests.

The newest M. genitalium assay joins the comprehensive list of men and women’s health assays by Hologic that include sexual and cervical health, and virology testing.

Thursday, September 6, 2018

The USPSTF reaffirms its recommendation for screening of all pregnant women for syphilis


The US Preventive Services Task Force (USPSTF) today reaffirmed its 2009 recommendation for early screening of all pregnant women for syphilis following a massive surge of cases of congenital syphilis. The statement was published September 4 in the JAMA with an accompanying editorial in JAMA Dermatology.

The newest guidance is a class ‘A’ recommendation which means that there exists substantial evidence in favor of the benefits of early screening for mother and fetus. 

Vertical transmission of syphilis can occur any time and at any stage during pregnancy, and congenital syphilis is associated with adverse outcomes such as preterm birth, low birth weight, stillbirth, congenital anomalies, active syphilis in the newborn (NB) and long-term health sequelae such bone deformities and neurologic impairment.

In the US, the incidence of congenital syphilis has increased by nearly 87% between 2012 to 2016, after a steady decline during the previous 4 years.  The rise coincides with rising national rates of syphilis among women of reproductive age – from 0.9 cases of primary and secondary syphilis infection per 100,000 women in 2012 to 1.9 cases in 2016.


The USPSTF recommends that all pregnant women should be screened for syphilis as early as possible when they present at the healthcare provider’s office. If a woman presents directly in labor and has not received any testing earlier, she should be immediately tested.

The screening test for syphilis is a two-step process– initially a “nontreponemal” antibody test (i.e., Venereal Disease Research Laboratory test or rapid plasma reagin [RPR] test) is done to detect biomarkers released from damage caused by syphilis infection, followed by a confirmatory “treponemal” antibody detection test (i.e., fluorescent treponemal antibody absorption or T pallidum particle agglutination test).

A newer alternative is a reverse sequence screening algorithm that involves an automated treponemal test (such as an enzyme-linked, chemiluminescence, or multiplex flow immunoassay first, followed by a nontreponemal test.


The CDC has recommended parenteral benzathine penicillin G for the treatment of syphilis in pregnant women. Evidence in favor of the safety of alternative treatment is limited; therefore, women who present with an allergy to penicillin should be evaluated and desensitized first and treated with the drug.

One way to decrease the incidence of congenital syphilis is to bring down the rates of primary and secondary syphilis infection among all women. Lower rates of syphilis in women prevent the sexual transmission and subsequent vertical transmission of congenital syphilis. Hence, the USPSTF recommends screening for syphilis in nonpregnant adolescents and adults at increased risk for infection.

The current recommendations are in accordance with those issued by other professional organizations. The CDC recommends screening for syphilis infection in all pregnant women at their first contact with the provider. The CDC, AAP, and ACOG also recommend repeat screening at 28 weeks of gestation and again at delivery in women who are at high risk for syphilis infection.

High-risk women include those with HIV or a history of incarceration or commercial sex worker. ACOG and AAP also recommend repeat screening after encountering an infected partner.