Background Risk of pelvic inflammatory disease associated with Chlamydia trachomatis and Mycoplasma genitalium is increased after termination of pregnancy (TOP) and may be increased after insertion of intrauterine devices (IUDs). Screening prior to these procedures is recommended only for C. trachomatis. We examined C. trachomatis and M. genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception service over 10 years.
Methods Retrospective analysis of clinical data collected from 17 573 women aged 15–45 years in 2009–2019 and for 266 M. genitalium positive women tested for macrolide resistance-associated mutations in 2016–2019.
Results C. trachomatis and M. genitalium prevalence was 3.7% and 3.4%, respectively. In multivariable analyses, shared risk factors were younger age (p<0.001, for both C. trachomatis and M. genitalium), socioeconomic disadvantage (p=0.045 and p=0.008, respectively) and coinfection (p<0.001, for both sexually transmitted infections), with 10.1% of C. trachomatis positive women also positive for M. genitalium. Additional risk factors were earlier year of visit (p=0.001) for C. trachomatis and for M. genitalium residing outside a major city (p=0.013). The proportion of M. genitalium infections tested between 2016 and 2019 with macrolide resistance-associated mutations was 32.7%.
Conclusions Given the high level of antimicrobial resistance and the prevalence of coinfection, testing C. trachomatis positive women for M. genitalium could be considered in this setting to prevent further spread of resistant infections. Further research is required into the causal link between M. genitalium and pelvic inflammatory disease in women undergoing TOP and IUD insertion.
- chlamydia trachomatis
- M genitalium
- sexual health
- antibiotic resistance
- pelvic inflammatory disease
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Handling editor Deborah Williamson
Contributors HSS codesigned the study, cleaned and analysed the data and drafted the paper. DAM designed the study, assisted in the data analyses and drafting of the paper and reviewed the paper for intellectual content. A-MC performed the data extraction and reviewed the paper for intellectual content. GM and JD assisted with study design and revised the paper for intellectual content. AM provided clinical guidance, reviewed the dataset and revised the paper for intellectual content. CB and KF provided clinical guidance and revised the paper for intellectual content. LV, JSH, JK, RG and SMG revised the paper for intellectual content.
Funding The work was supported by National Health and Medical Research Council program (Grant number 568971).
Disclaimer The views expressed in this publication do not necessarily represent the position of the Australian Government.
Competing interests SMG reports personal fees from Merck, grants from Merck, other from Merck, outside the submitted work. GM reports grants from Innovations Connections and grants from Victorian Medical Research Acceleration Fund, outside the submitted work. CB reports Melbourne Sexual Health Centre has received research support from SpeeDx Pty Ltd.
Provenance and peer review Not commissioned; externally peer reviewed.
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