Mycoplasma genitalium in Women: Current Knowledge and Research Priorities for This Recently Emerged Pathogen

Abstract

Health consequences of sexually transmitted diseases disproportionately affect women, making it important to determine whether newly emerged pathogens cause sequelae. Although the pathogenic role of Mycoplasma genitalium in male urethritis is clear, fewer studies have been conducted among women to determine its pathogenic role in the female reproductive tract. Pelvic inflammatory disease (PID) is an important cause of infertility and ectopic pregnancy, and Chlamydia trachomatis and Neisseria gonorrhoeae are recognized microbial causes. Emerging data demonstrate an association between M. genitalium and PID, and limited data suggest associations with infertility and preterm birth, yet the attributable risk for female genital tract infections remains to be defined. Further investigations are needed to better define the impact of M. genitalium on women's reproductive health. Importantly, prospective studies evaluating whether screening programs and targeted treatment of M. genitalium improve reproductive outcomes in women are necessary to guide public health policy for this emerging pathogen.

Keywords: Mycoplasma genitalium; cervicitis; infertility; pelvic inflammatory disease; preterm birth.

Figure 1.

Summary effect sizes from meta-analysis of the association between Mycoplasma genitalium infection and 5 female reproductive tract disease syndromes Adapted from Lis et al [7]. Abbreviation: CI, confidence interval.

Figure 2.

The effect of infection with Mycoplasma genitalium on the human fallopian tube epithelium. Notice that the cilia of the ciliated cells are harmed by the infection. A, The close-up shows that swelled cilia may have many shapes and swelling can appear at different places of the cilia: at the basal, middle, or distal part of the cilium. B, Cilia literally fall apart, many of them are shortened, and the number of cilia per cell is markedly reduced. Structures similar to M. genitalium cells can be seen in the preparation, adhering to the secretory cells, and are indicated with arrows. Secretory cells are not affected by M. genitalium infection. C, Affected ciliated cells with 2 dead cells that are still partly attaching to the human fallopian tube tissue. Reprinted with permission from Baczynska et al [47].