More Trials Need to Assess Effect of M genitalium on Female Reproductive Health Outcomes

Young, asymptomatic, high-risk women in the United States have high rates of prevalent, incident, and persistent M genitalium infections, supporting the need for clinical trials to assess the effect of M genitalium screening programs on female reproductive health outcomes.

There is a high prevalence of persistent Mycoplasma genitalium among young, high-risk women with asymptomatic bacterial vaginosis highlighting the need for more clinical trials assessing the effect of M genitalium screening on female reproductive health outcomes, according to new research published in Clinical Infectious Diseases.1

In a recent meta-analysis, M genitalium was found to be associated with cervicitis, pelvic inflammatory disease, spontaneous abortion, and preterm birth.2 To determine the prevalence, incidence, and natural history of M genitalium and factors associated with infection in young, high-risk women, researchers conducted a prospective study recruiting women from 10 sites across the United States. Vaginal swabs of women (aged 15-25 years) with asymptomatic bacterial vaginosis at time of enrollment were collected, as well as swabs from home testing every 2 months for 12 months as follow-up.

Prevalence of M genitalium was 20.5% (95% CI, 18.2% to 22.90%) among 1139 women, and 20.6% of the women were identified with persistent M genitalium. Women aged 15 to 21 years had a higher prevalence (22.6%) than those aged 22 to 25 years (17.7%).

Factors associated with M genitalium prevalence were black race (adjusted odds ratios [AOR] 1.92; 95% CI, 1.09-3.38), age ≤21 years (AOR, 1.40; 95% CI, 1.03-1.91), and history of prior pregnancy (AOR, 1.36; 95% CI, 1.00-1.85). Only black race was associated with incident M genitalium, defined as a positive test before a negative result at enrollment (P =.03).

An incidence rate of 36.6/100 person-years was calculated on the basis of the findings across the 10 sites.

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This study focused on high-risk women with asymptomatic bacterial vaginosis and cannot be extrapolated to other women >25 years of age, but the results are concerning, as they show M genitalium has some of the highest prevalence and incidence rates of sexually transmitted infections in the United States.

“Our findings in the context of the published literature suggest that a targeted [M genitalium] screening and treatment program among certain populations…could be a highly effective public health intervention,” and there exists “an urgent need for research designed to test this hypothesis,” concluded the researchers.


  1. Seña AC, Lee JY, Schwebke J, et al. A silent epidemic: the prevalence, incidence and persistence of Mycoplasma genitalium among young, asymptomatic high-risk women in the United States [published online January 12, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy025
  2. Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis. 2015;61:418-426.