Background While the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine the prevalence of MG and macrolide resistance, and its association with common genital symptoms in women attending a sexual health service, to inform indications for testing and clinical practice.
Methods We undertook a cross-sectional study of symptomatic and asymptomatic women attending Melbourne Sexual Health Centre (MSHC), between April 2017 and April 2019. Women were tested for MG and macrolide resistance, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis and vulvovaginal candidiasis. Women completed a questionnaire on symptoms, and symptomatic women underwent examination. The prevalence of MG (and macrolide resistance) and other genital infections was calculated with 95% CIs, and associations between these outcomes and specific genital symptoms were examined using logistic regression.
Results Of 1318 women, 83 (6%, 95% CI: 5% to 8%) had MG, of which 39 (48%, 95% CI: 36% to 59%) had macrolide-resistant MG; 103 (8%, 95% CI: 6% to 9%) women had CT. MG prevalence was similar in asymptomatic (10 of 195; 5%) and symptomatic (73 of 1108; 7%) women, p=0.506. MG was associated with mucopurulent cervicitis on examination (adjusted OR=4.38, 95% CI: 1.69 to 11.33, p=0.002), but was not associated with other specific genital symptoms or signs.
Conclusions MG was as common as CT among women attending MSHC. MG was not associated with genital symptoms, but like CT, was significantly associated with cervicitis. These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated. The presence of macrolide resistance in 48% of women supports use of resistance-guided therapy.
- Mycoplasma genitalium
- SEXUAL HEALTH
- Uterine Cervicitis
- Genital Diseases
- Chlamydia Infections
Data availability statement
No data are available. Data generated are confidential as they relate to patients at MSHC.
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Handling editor Deborah Williamson
Twitter @lenkavod, @EricPFChow
Contributors RLL wrote the ethics application, study protocol and study materials, assisted with data entry, performed data analysis and wrote the first draft of the manuscript, and assisted with reviewers' comments. LV provided extensive assistance with the data analysis and provided input into manuscript and reviewers' comments. ELP performed data analysis and extensive input into the manuscript, and assistance with reviewers' comments. MD put together study packs, completed data entry and maintained patient records, notified patients of test results, and provided input into the manuscript. GM provided input into the study protocol, coordinated testing of study samples and provided input into the manuscript. CKF provided input into the study protocol and manuscript. KB performed testing of study samples and provided input into the manuscript. TRHR assisted with the ethics application and study protocol, as well as design of the questionnaire and analysis. MK assisted with data entry and provided input into the manuscript. EM provided input into the study protocol and manuscript. RG provided input into the study protocol and manuscript. EPFC provided input into the study protocol and manuscript. CB formulated the study concept, assisted with study protocol and data analysis, and provided input into the manuscript and reviewers' comments.
Funding Melbourne Sexual Health Centre received funding from SpeeDx Pty Ltd (Australia) in support of this research project. RLL and ELP are supported by an Australian Government Research Training Program (RTP) Scholarship, TRHR by a NHMRC early career fellowship no.1091536 and CSB by an NHMRC Investigator Leadership Grant (APP1173361).
Competing interests Melbourne Sexual Health Centre received funding from SpeeDx (Australia) in support of this research project. The remaining authors report no conflict of interest.
Provenance and peer review Not commissioned; externally peer reviewed.
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