Reviewer ’s report  
 
Title: Prevalence of Mycoplasma genitalium Infection in Women with Bacterial Vaginosis.  
 
Version: 0 Date: 28 Jan 2020  
 
Reviewer: Joana Castro  
 
Reviewer's report:  
The study "Prevalence of Mycoplasma genitalium Infection in Women with Bacterial Vaginosis" 
by Nye et al., has some strengths and limitations. This study is timely. However, the manuscript 
needs minor clarificati on. As such, in the comments to the authors, do have some suggestions for 
its improvement.  
 
General comments:  
The authors should consider changing the term "vaginitis" in the manuscript. As an alternative, 
the authors can use - vaginal infection. The term  "infectious vaginitis" is often used to address 
vaginal infections, although not totally correct. In fact, not all vaginal infections present 
inflammatory signs and symptoms as suggested by the "itis" medical terminology. A particular 
case is BV, that is some cases an inflammatory response is lacking (Reid G. Appl Microbiol 
Biotechnol 2018;102:553 -8.; Rosca et al.  FEMS Microbiol Rev. 2019. pii: fuz027).  
  
 
ABSTRACT:  
1. Line 16.  The authors should reconsider to use "BV" instead "Bacterial Vaginosis" sinc e 
the authors have introduced such abbreviation on line 3.  
 
BACKGROUND:  
1. Page 3 - Line 7. For each association of M. genitalium with acute and chronic conditions 
should be added a reference instead add all the references together at the end of the sente nce. 
2. Page 5 - Line 13. Please consider adding the extensive abbreviation of HIV.  
 
 
MATERIAL AND METHODS:  
1. Page 5 - Line 13.  Given the fact that the authors also used the Nugent criteria (gold 
standard method for BV diagnosis), the sentence "according  to Amsel criteria" should be 
changed to "according to Amsel [reference number] criteria and to Nugent criteria [reference 
number]". Re -phrasing lines  between 15 -21. 
2. Page 6 - Line 1: As the authors used the terminology of BV, they should also consider 
using Vulvovaginal candidiasis (VVC) for candida infections. The authors should provide the 
sequence of the primers used to detected Candida spp. Such information can be added as 
supplementary material.  
3. Page 6 - Line 6: For Trichomonas vaginalis infecti ons, the authors should use TV.  
 
RESULTS  
1. Page 8 - Line 8: M. genitalium prevalence was not associated with positive Amsel results. 
However, the authors also diagnosed BV according to Nugent criteria. Some samples could be 
positive according to Nugent score, but BV -negative according to Amsel c riteria. It is well 
known that Nugent criteria (that is the gold standard method for BV diagnosis) is more sensible 
than Amsel criteria; and that in some cases BV is asymptomatic. The authors should clarify how 
the analysis was done.  
 
DISCUSSION  
1. Page 9  - Line 1: It is the first time that the authors used "MG". In the manuscript, all the 
mentions to MG are referred by M. genitalum. Please consider maintaining the same terminology 
in all the manuscript.   
2. Page 9 - Line 7: The authors have used both Ams el and Nugent criteria to diagnose BV. 
Based on Amsel criteria, the symptoms associated with BV were evaluated. Please clarify the 
limitation presented on lines 7 - 9 and re -phrasing. It would great to perform follow -up studies, 
and the absence of such a s tudy could be a limitation of this manuscript.  
3. Page 9 - Line 17/Pag 11 - Line 7. Microbiota has been used more recently than 
microflora in the field as microflora incorrectly classifies bacteria to plant kingdom. Please 
consider changing the term.  
 
4. Page 10 - Line 7 -9. "We did not observe an association between clinical manifestations of 
BV, as assessed by Amsel scores, and M. genitalium prevalence (Table 1)." The authors also 
diagnosed BV according to Nugent criteria. Some samples could be positive ac cording to Nugent 
score, but BV -negative according to Amsel criteria (clinical criteria). Please clarify if there is 
some difference in the results according to this fact.  
 
 
TABLE  
Table 1. The authors should consider changing the terms of the column of "ch aracteristic". In the 
text, Candida appears first than Trichomonas, so herein the authors should have the same order. 
Furthermore, the authors should consider changing "Trichomonas" by "TV" and "candida" by 
"VVC".  
 
Table 2. Please clarify if the cases diag nosed as BV -negative according to Amsel criteria, but 
BV-positive according to Nugent criteria were included in the analysis.  
 
Are the methods appropriate and well described?  
If not, please specif y what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Yes 
 
Are the conclusions drawn adequately supported by the  data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
Are you able to assess any statistics in the manus cript or would you recommend an 
additional statistical review?  
If an additional statistical review is recommended, pleas e speci fy what aspects require further 
assessment in your comments to the editors.  
 
I am able to assess the statistics  
 
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
Declaration of competing interests  
Please complete a declaration of competing interests, considering the following questions:  
 
1. Have you in the past five years received reimbursements, fees, funding, or salary from an  
organisation that may in any way gain or lose financially from the publi cation of this  
manuscript, either now or in the future?  
 
2. Do you hold any stocks or shares in an organisation t hat may in any way gain or lose 
financially from the publication of this manuscript, either now or in the future?  
 
3. Do you hold or are you curr ently applying for any patents  relating to the content of the 
manuscript?  
 
4. Have you received reimbursements, fees, funding, or salary from an organization that 
holds  or has applied for patents relating to the content of the manuscript?  
 
5. Do you have any  other financial competing interests?  
 
6. Do you have any non -financial competing interests in relation to this paper?  
 
If you can answer no to all of the above, write 'I declare that I have  no competing interests' 
below. If your reply is yes to any, please give details below.  
 
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