Background Mycoplasma genitalium is increasingly seen as an emerging sexually transmitted pathogen, and has been likened to Chlamydia trachomatis, but its natural history is poorly understood. The objectives of this systematic review were to determine M. genitalium incidence, persistence, concordance between sexual partners and the risk of pelvic inflammatory disease (PID).
Methods We searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.
Results We screened 4634 records and included 18 studies; six (4201 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI 0.61 to 1.53, I2 0%). Median persistence of M. genitalium was estimated from one to three months in four studies but 15 months in one study. In 10 studies measuring M. genitalium infection status in couples, 39%–50% of male or female sexual partners of infected participants also had M. genitalium detected. In prospective studies, PID incidence was higher in women with M. genitalium than those without (risk ratio 1.73, 95% CI 0.92 to 3.28, I2 0%, two studies).
Discussion Incidence of M. genitalium in very highly developed countries is similar to that for C. trachomatis, but concordance might be lower. Taken together with other evidence about age distribution and antimicrobial resistance in the two infections, M. genitalium is not the new chlamydia. Synthesised data about prevalence, incidence and persistence of M. genitalium infection are inconsistent. These findings can be used for mathematical modelling to investigate the dynamics of M. genitalium.
Registration numbers CRD42015020420, CRD42015020405
- infectious diseases
- systematic reviews
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Handling editor Jane S Hocking
Contributors Conceived and designed the review: LB, MC, NL, PS. Screened titles, abstracts and full texts: LB, MC, NL. Extracted the data: HA, LB, MC, DE-G. Analysed the data: LB, MC, FH, NL. Wrote the first draft: MC. Revised the paper before submission: HA, LB, MC, DE-G, FH, NL, PS. Approved the final version: HA, LB, MC, DE-G, FH, NL, PS.
Funding This study received funding from the Swiss National Science Foundation (grant nos. 320030_173044 and 32003B-160320) and Swiss Programme for Research on global issues for Development (r4d): grant no. IZ07Z0_160909.
Competing interests NL is deputy editor of Sexually Transmitted Infections.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Not applicable. We are not submitting an original research article.
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