Abstract
This study characterizes the epidemiology of Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and herpes simplex virus (HSV) in real-world obstetrics and gynecology outpatient settings in Xihu District, Hangzhou. Given the elevated positivity among younger women, targeted health education and management strategies are warranted.
Introduction
Reproductive tract infections (RTIs) caused by pathogens such as Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and herpes simplex virus (HSV) are significant contributors to infertility, pelvic inflammatory disease, and adverse pregnancy outcomes. A major challenge in managing these infections is that they are frequently asymptomatic, allowing them to go undetected and sustain hidden transmission chains.
While global epidemiological estimates are available, regional data are essential for developing effective public health strategies and clinical guidelines. This study addresses the lack of recent, large-scale data in the Xihu District of Hangzhou, China, focusing on co-infection patterns, age-related variations, and the evolving antibiotic resistance of UU.
Methods
A retrospective analysis was conducted on 5,577 female genital tract specimens collected between January 2018 and December 2024 at Tongde Hospital of Zhejiang Province. The cohort consisted primarily of symptomatic patients (94.85%), with a median age of 30 years.
Pathogen DNA for UU, CT, NG, and HSV-1/2 was detected using real-time PCR. For UU-positive samples, antibiotic susceptibility was tested against 10 different drugs using a commercial kit. Statistical analysis included chi-square tests, Spearman’s rank correlation for temporal trends, and multivariable logistic regression to identify risk factors.
Results and Discussion
Pathogen Prevalence and Co-infection
The study found high positivity rates for several pathogens, with UU being the most prevalent at 49.11%, followed by HSV (10.52%), CT (7.48%), and NG (1.88%). The overall pathogen positivity rate showed a significant increase over the seven-year study period ($p < 0.01$).
A key finding was the role of UU as a "co-infection anchor." Among patients with mixed infections, UU was present in over 96% of cases. The most frequent combination was UU+CT, accounting for 71.63% of co-infections. Logistic regression confirmed that UU-positive patients were 2.34 times more likely to also have a CT infection, suggesting that UU might compromise epithelial barriers, facilitating the entry of other pathogens.
Age-Related Risk Factors
The data highlighted a significant vulnerability in younger women. Those aged 19 and younger exhibited the highest positivity rates for UU, CT, NG, and HSV-1. This pattern is likely driven by a combination of active sexual behavior and biological factors such as cervical ectopy, which increases mucosal vulnerability. Interestingly, while HSV-1 was more common in younger women, HSV-2 positivity peaked in women over 60, indicating distinct epidemiological profiles for the two virus types.
Antibiotic Resistance in U. urealyticum
The study revealed a stark divide in the efficacy of treatments for UU. Traditional "workhorse" antibiotics like doxycycline, josamycin, and minocycline remain highly effective, with susceptibility rates exceeding 95%. In contrast, newer fluoroquinolones have experienced a collapse in efficacy; susceptibility to ofloxacin and ciprofloxacin has dropped below 16%, representing a trend of "explosive resistance."
Conclusion
This large-scale study underscores the high prevalence of UU and the specific risks faced by younger women in Hangzhou. The findings emphasize the need for targeted health education for youth and the careful selection of antibiotics for UU treatment, favoring tetracyclines over fluoroquinolones. While limited by its single-center, retrospective design, this research provides a vital foundation for future prospective, multicenter studies to further refine regional public health strategies.