Prevalence of Mycoplasma genitalium (MG) in women living with HIV in Johannesburg, South Africa, was 7.4% (95% CI, 5.5-9.7), according to the results of a prospective cohort study of 662 women published in Clinical Infectious Diseases.

Researchers analyzed cervical specimen from 622 women aged 25 to 50 years, who were recruited from primary health centers and communities surrounding Johannesburg, South Africa, from December 2011 to October 2012. Detection of M genitalium was more likely in women with lower CD4 counts (adjusted odds ratio [aOR] 1.02 per 10 cells/L decrease; 95% CI, 1.00-1.03) and higher plasma HIV-1 RNA (aOR 1.15 per log copies/mL increase; 95% CI,1.03-1.27). There were no mutations as a result of resistance against macrolide or quinolone antibiotics found in the samples. However, researchers noted that approximately one-third of women with M genitalium at baseline had detectable measures of the bacteria after a median of 16 months.

This report showed that M genitalium infection is as common as other cervical sexually transmitted infections occurring in women in South Africa who are living with HIV. Of note, it was the second most common cause of cervical infection in the cohort. The results also showed that M genitalium was associated with higher viral load and lower CD4 counts; researchers suggested 2 possible explanations: (1) M genitalium  may persist as a result of uncontrolled HIV replication, or (2) M genitalium may contribute to increased HIV replication. However, investigators noted that, “little is known of reciprocal interactions.” Further, they concluded that M genitalium antimicrobial resistance requires ongoing monitoring due to the inclusion of macrolides into the national guidelines for syndromic management of genital discharge and pelvic inflammatory disease syndromes that were made in 2015.

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Reference

Ong JJ, Magooa MP, Chikandiwa A, et al. Prevalence and antimicrobial resistance of Mycoplasma genitalium infection among women living with HIV in South Africa: a prospective cohort study [published online January 29 2019]. Clin Infect Dis. doi:10.1093/cid/ciz045