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. 2022 Jun;98(4):277-285.
doi: 10.1136/sextrans-2020-054818. Epub 2021 Jul 1.

The clinical indications for testing women for Mycoplasma genitalium

Rosie L Latimer  1   2 , Lenka A Vodstrcil  3   2 , Erica L Plummer  3   2 , Michelle Doyle  3 , Gerald L Murray  4   5   6 , Christopher K Fairley  3   2 , Kaveesha Bodiyabadu  4   5   7 , Tim R H Read  3   2 , Marti Kaiser  3 , Elisa Mokany  7 , Rebecca Guy  8 , Eric P F Chow  3   2 , Catriona Bradshaw  3   2
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The clinical indications for testing women for Mycoplasma genitalium

Rosie L Latimer et al. Sex Transm Infect. 2022 Jun.

Abstract

Background: While the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine the prevalence of MG and macrolide resistance, and its association with common genital symptoms in women attending a sexual health service, to inform indications for testing and clinical practice.

Methods: We undertook a cross-sectional study of symptomatic and asymptomatic women attending Melbourne Sexual Health Centre (MSHC), between April 2017 and April 2019. Women were tested for MG and macrolide resistance, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis and vulvovaginal candidiasis. Women completed a questionnaire on symptoms, and symptomatic women underwent examination. The prevalence of MG (and macrolide resistance) and other genital infections was calculated with 95% CIs, and associations between these outcomes and specific genital symptoms were examined using logistic regression.

Results: Of 1318 women, 83 (6%, 95% CI: 5% to 8%) had MG, of which 39 (48%, 95% CI: 36% to 59%) had macrolide-resistant MG; 103 (8%, 95% CI: 6% to 9%) women had CT. MG prevalence was similar in asymptomatic (10 of 195; 5%) and symptomatic (73 of 1108; 7%) women, p=0.506. MG was associated with mucopurulent cervicitis on examination (adjusted OR=4.38, 95% CI: 1.69 to 11.33, p=0.002), but was not associated with other specific genital symptoms or signs.

Conclusions: MG was as common as CT among women attending MSHC. MG was not associated with genital symptoms, but like CT, was significantly associated with cervicitis. These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated. The presence of macrolide resistance in 48% of women supports use of resistance-guided therapy.

Keywords: Chlamydia Infections; Female; Genital Diseases; Mycoplasma genitalium; SEXUAL HEALTH; Uterine Cervicitis.

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Conflict of interest statement

Competing interests: Melbourne Sexual Health Centre received funding from SpeeDx (Australia) in support of this research project. The remaining authors report no conflict of interest.

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