Objective Mycoplasma genitalium (MG) is a sexually transmitted organism associated with cervicitis and pelvic inflammatory disease in women and has been shown to increase the risk of HIV acquisition and transmission. Little is known about the prevalence and incidence of MG in pregnant women. Our study sought to evaluate the prevalence and incidence of MG infection in HIV-infected and HIV-uninfected pregnant women.
Methods We conducted a cohort study of 197 women ≥18 years receiving antenatal care in South Africa from November 2017 to February 2019. We over-recruited HIV-infected pregnant women to compare MG by HIV infection status. Self-collected vaginal swabs, performed at the first antenatal visit, third trimester and within 1 week post partum, were tested for MG using the Aptima assay (Hologic, USA). We report on the prevalence and incidence of MG and used multivariable logistic regression to describe correlates of MG and adverse pregnancy and birth outcomes (preterm delivery, miscarriage and vertical HIV transmission), adjusting for maternal age and HIV infection status.
Results At first antenatal visit, the median age was 29 years (IQR=24–34) and the gestational age was 19 weeks (IQR=14–23); 47% of women enrolled in the study were HIV-infected. MG prevalence was 24% (95% CI 16% to 34%, n=22) in HIV-infected and 12% (95% CI 6.8% to 20%, n=13) in HIV-uninfected pregnant women. MG incidence during pregnancy and early post partum was 4.7 infections per 100 woman-years (95% CI 1.2 to 12.9) or 3.9 per 1000 woman-months (95% CI 1.0 to 10.7). Adjusting for maternal age, HIV-infected women had over three times the odds of being infected with MG (adjusted OR=3.09, 95% CI 1.36 to 7.06).
Conclusion We found a high prevalence and incidence of MG in pregnant women. Younger maternal age and HIV infection were associated with MG infection in pregnancy. Further research into birth outcomes of women infected with MG, including vertical transmission of HIV infection, is needed.
- M genitalium
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Handling editor Laith J Abu-Raddad
Contributors CPS, HG and DJD collaborated in the writing of the manuscript. DJD designed and conducted the study and data collection. CPS, HG and DJD performed the statistical analyses. DN, YQ, RP, LM and JK reviewed the manuscript before submission. DJD and JK determined the hypotheses to be tested.
Funding DJD and LM received funding from NIMH (R01MH116771). DJD also received funding from NIH/Fogarty International Center (K01TW011187).
Competing interests We received STI testing kits from Cepheid and Hologic.
Patient consent for publication Not required.
Ethics approval Ethical approval and oversight were provided by the Faculty of Health Sciences Human Research Ethics Committee at the University of Cape Town (#454/2017) and the University of California Los Angeles (#19-000237). Written informed consent was obtained from all participants before enrolment, including for storage and future use of samples.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Analyses were performed from data collected from women attending an antenatal care clinic. Data were maintained in a database using deidentified participant coding. Additional information can be made available on request.