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

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<i>M genitalium</i> prevalence was higher among women aged 15 to 21 years than those aged 22 to 25 years. <i>Photo Credit: SPL/Science Source.</i>
M genitalium prevalence was higher among women aged 15 to 21 years than those aged 22 to 25 years. Photo Credit: SPL/Science Source.

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.

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.

References

  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.
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