One in five high-risk women with asymptomatic bacterial vaginosis also had Mycoplasma genitalium infection, study data showed.
“Presently, there is little information regarding the natural history of [M. genitalium],” Arlene C. Seña, MD, MPH, associate professor of medicine at the University of North Carolina, Chapel Hill, and colleagues wrote. “Earlier studies noted its persistence among women in the United Kingdom and female sex workers in Africa, but the persistence rate among sexually active women in the United States is unknown. [M. genitalium] persistence may be due to a lack of detection in asymptomatic persons or antimicrobial resistance to therapy, potentially leading to chronic infections and long-term complications such as infertility.”
The researchers recruited 1,139 women aged 15 to 25 years from 10 sites in North Carolina, California, Alabama, Pennsylvania and Maryland. All patients had asymptomatic bacterial vaginosis, reported vaginal intercourse in the past 3 months, and had two or more risk factors for STIs, including black race and having multiple sex partners in the past year. Seña and colleagues collected vaginal swabs from the women at enrollment, followed by home-based testing every 2 months over the course of 1 year, and performed testing for M. genitalium with transcription-mediated assays. The researchers then estimated the prevalence, incidence and persistence of M. genitalium, and evaluated characteristics associated with infection.
The patients’ median age was 21 years, and most were black (84.1%), the researchers wrote. Nearly half (47.9%) reported that they had only one partner for vaginal sex over the previous year; however, slightly more than half (50.6%) reported that they had a new sexual partner in the past year, and 52.5% had engaged in oral sex. Most patients had previously been pregnant (54.8%).
Overall, 233 women tested positive for M. genitalium — a prevalence of 20.5% (95% CI, 18.2-22.9). Of 204 who had available samples during follow-up, 42 (20.6%) had persistent M. genitalium infection, the researchers said. Among 801 women who were negative for M. genitalium at baseline, the incidence of the infection was 36.6 per 100 person-years (95% CI, 32.4-41.3).
Several risk factors, including black race (adjusted OR = 1.92; 95% CI, 1.09-3.38), being aged 21 years or younger (aOR = 1.4; 95% CI, 1.03-1.91) and a prior pregnancy (aOR = 1.36; 95% CI, 1-1.85) were associated with prevalent M. genitalium, the researchers reported, whereas the only risk factor associated with incident infection was black race (P = .03).
“Prior investigations had indicated that the low prevalence of [M. genitalium] among asymptomatic women would result in low-yield screening efforts,” Seña and colleagues wrote. “Our findings in the context of the published literature suggest that a targeted [M. genitalium] screening and treatment program among certain populations could be a highly effective public health intervention; however, there is an urgent need for research designed to test this hypothesis.” – by Andy Polhamus
Disclosures: Seña reports receiving royalties from UptoDate, and FOCUS grant funding from Gilead Sciences. Please see the study for all other authors’ relevant financial disclosures.