Objectives: The aim of this study was to examine the prevalence of Mycoplasma genitalium in a large number of female patients attending a sexually transmitted infections (STI) clinic and to determine if there is an association with signs or symptoms of lower genital tract inflammation (LGTI).
Methods: 7646 female patients who had symptoms or microscopic signs of LGTI or were perceived to be at high risk of exposure to an STI were tested for both M. genitalium and C. trachomatis. Urethral and cervical smears were examined quantitatively for polymorphic mononuclear leucocytes.
Results: The prevalence of C. trachomatis and M. genitalium was 10.1% and 4.5%, respectively. We found a clear association between detecting M. genitalium in first void urine (FVU) of patients and signs of urethral inflammation. The strongest association was between detecting M. genitalium in FVU and number of polymorphic mononuclear leucocytes (PMNL) in urethral smears (n=6790, OR=2.1, CI=1.5-2.9). The association was less significant between detecting M. genitalium in cervical swabs and number of PMNL in urethral smears (n=6785, OR=1.4, CI=1.1-1.9), although cervical swabs gave higher sensitivity than FVU in detecting M. genitalium (86% vs. 62%). C. trachomatis detection in FVU and cervical swabs was highly concordant and both significantly associated with urethritis (n=6790, OR=3.6, CI=3-4.4).
Conclusions: This data supports the hypothesis that M. genitalium causes urethritis in women and that M. genitalium infection of the genitourinary tract leads to different clinical manifestations, depending on whether the site of infection is the urethral or the cervical epithelium.
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