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  • Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009–2019

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Epidemiology
Original research
Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009–2019
  1. Hannah S Shilling1,2,
  2. Suzanne M Garland1,2,
  3. Anna-Maria Costa3,
  4. Alex Marceglia4,5,
  5. Katherine Fethers4,5,
  6. Jennifer Danielewski1,2,
  7. Gerald Murray1,2,
  8. Catriona Bradshaw5,6,
  9. Lenka Vodstrcil5,6,
  10. Jane S Hocking7,
  11. John Kaldor8,
  12. Rebecca Guy8,
  13. Dorothy A Machalek1,8
  1. 1 Centre for Women’s Infectious Diseases, Royal Women's Hospital, Parkville, Victoria, Australia
  2. 2 Molecular Microbiology group, Murdoch Children's Research Institute, Parkville, Victoria, Australia
  3. 3 Laboratory Services, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
  4. 4 Sexual Health and Rapid Access Service, Royal Women's Hospital, Parkville, Victoria, Australia
  5. 5 Melbourne Sexual Health Centre, Carlton, Victoria, Australia
  6. 6 Central Clinical School, Monash University, Clayton, Victoria, Australia
  7. 7 Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
  8. 8 The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
  1. Correspondence to Dr Dorothy A Machalek, Centre for Women’s Infectious Diseases, Royal Women's Hospital, Parkville, VC 3052, Australia; dorothy.machalek{at}thewomens.org.au

Abstract

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

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/sextrans-2020-054695

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • Handling editor Deborah Williamson

    • Twitter @lenkavod

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.