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. 2022 Mar;98(2):115-120.
doi: 10.1136/sextrans-2020-054695. Epub 2021 Mar 29.

Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019

Hannah S Shilling  1   2 , Suzanne M Garland  1   2 , Anna-Maria Costa  3 , Alex Marceglia  4   5 , Katherine Fethers  4   5 , Jennifer Danielewski  1   2 , Gerald Murray  1   2 , Catriona Bradshaw  5   6 , Lenka Vodstrcil  5   6 , Jane S Hocking  7 , John Kaldor  8 , Rebecca Guy  8 , Dorothy A Machalek  9   8
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Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019

Hannah S Shilling et al. Sex Transm Infect. 2022 Mar.

Abstract

Background: Risk of pelvic inflammatory disease associated with Chlamydia trachomatis and Mycoplasma genitalium is increased after termination of pregnancy (TOP) and may be increased after insertion of intrauterine devices (IUDs). Screening prior to these procedures is recommended only for C. trachomatis. We examined C. trachomatis and M. genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception service over 10 years.

Methods: Retrospective analysis of clinical data collected from 17 573 women aged 15-45 years in 2009-2019 and for 266 M. genitalium positive women tested for macrolide resistance-associated mutations in 2016-2019.

Results: C. trachomatis and M. genitalium prevalence was 3.7% and 3.4%, respectively. In multivariable analyses, shared risk factors were younger age (p<0.001, for both C. trachomatis and M. genitalium), socioeconomic disadvantage (p=0.045 and p=0.008, respectively) and coinfection (p<0.001, for both sexually transmitted infections), with 10.1% of C. trachomatis positive women also positive for M. genitalium. Additional risk factors were earlier year of visit (p=0.001) for C. trachomatis and for M. genitalium residing outside a major city (p=0.013). The proportion of M. genitalium infections tested between 2016 and 2019 with macrolide resistance-associated mutations was 32.7%.

Conclusions: Given the high level of antimicrobial resistance and the prevalence of coinfection, testing C. trachomatis positive women for M. genitalium could be considered in this setting to prevent further spread of resistant infections. Further research is required into the causal link between M. genitalium and pelvic inflammatory disease in women undergoing TOP and IUD insertion.

Keywords: M genitalium; antibiotic resistance; chlamydia trachomatis; pelvic inflammatory disease; sexual health.

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Conflict of interest statement

Competing interests: SMG reports personal fees from Merck, grants from Merck, other from Merck, outside the submitted work. GM reports grants from Innovations Connections and grants from Victorian Medical Research Acceleration Fund, outside the submitted work. CB reports Melbourne Sexual Health Centre has received research support from SpeeDx Pty Ltd.

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