Abstract
BACKGROUND: Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), and herpes simplex virus types 1 and 2 (HSV-1 and HSV-2) are common etiologic agents of reproductive tract infections (RTIs) with high global prevalence and the potential to cause adverse genital outcomes. This study assessed the positivity rates and co-infection patterns of UU, CT, NG, and HSV among women in Xihu District, Hangzhou, Zhejiang Province, China. METHODS: We analyzed 5,577 female genital tract specimens collected from January 2018 to December 2024 at Tongde Hospital of Zhejiang Province. Pathogen DNA was detected using real-time PCR. UU susceptibility testing was performed with the Mycoplasma Identification and Susceptibility Test Kit. RESULTS: Among 5,577 specimens, positivity rates were 49.11% for UU, 7.48% for CT, 1.88% for NG, and 10.52% for HSV. A total of 118 mixed infections involving two or more pathogens were identified; the most frequent combination was UU + CT, accounting for 73.73% of mixed infections. UU was the most common organism in co-infections, present in more than 96% of mixed-infection cases. Significant associations were observed between UU and CT (p < 0.001) and between UU and NG (p < 0.05). The overall pathogen positivity rate increased over the seven-year period (p < 0.01). Younger women (≤ 19 years) had the highest positivity for UU, CT, NG, and HSV-1, whereas older women (> 60 years) had the highest HSV-2 positivity. More than 95% of UU isolates were susceptible to doxycycline, minocycline, and josamycin. CONCLUSIONS: This study characterizes the epidemiology of UU, CT, NG, and 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.