Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women?

Abstract

Mycoplasma genitalium is a facultative anaerobic organism and a recognized cause of nongonococcal urethritis in men. In women, M. genitalium has been associated with cervicitis, endometritis, pelvic inflammatory disease (PID), infertility, susceptibility to human immunodeficiency virus (HIV), and adverse birth outcomes, indicating a consistent relationship with female genital tract pathology. The global prevalence of M. genitalium among symptomatic and asymptomatic sexually active women ranges between 1 and 6.4%. M. genitalium may play a role in pathogenesis as an independent sexually transmitted pathogen or by facilitating coinfection with another pathogen. The long-term reproductive consequences of M. genitalium infection in asymptomatic individuals need to be investigated further. Though screening for this pathogen is not currently recommended, it should be considered in high-risk populations. Recent guidelines from the Centers for Disease Control regarding first-line treatment for PID do not cover M. genitalium but recommend considering treatment in patients without improvement on standard PID regimens. Prospective studies on the prevalence, pathophysiology, and long-term reproductive consequences of M. genitalium infection in the general population are needed to determine if screening protocols are necessary. New treatment regimens need to be investigated due to increasing drug resistance.

Prevalence of Mycoplasma genitalium and other sexually-transmitted pathogens among high-risk individuals in Greece

“…9 In women, MG infection has been associated with urethritis, cervicitis, pelvic inflammatory disease, susceptibility to HIV, adverse pregnancy outcomes and infertility. 10 Through intracellular localization 11 and antigenic variation, 12 MG could result in treatment-resistant chronic infection. 10 Molecular assays are currently employed, with high sensitivity, as the major diagnostic techniques for MG infection, although, at present they rely only on in-house protocols, as FDA-approved ones are not available.…”

Mycoplasma genitalium, an agent of reemerging sexually transmitted infections

“…M. genitalium is a sexually transmissible micro‐organism distributed worldwide with a prevalence which varies depending on the country and population group being studied . In the general population, the prevalence of M. genitalium ranges from 1‐4% in males and 1–6% in females and can reach 38% in patients at high risk of STIs . In males, M. genitalium is a recognized cause of urethritis and represents approximately 15–20% of non‐gonococcal urethritis cases and approximately 30% of persistent or recurrent urethritis cases .…”

Sexually Transmitted Infections: Compelling Case for an Improved Screening Strategy

“…Further, studies have demonstrated higher rates of Mgen antibodies in women with tubal factor infertility as compared to fertile women, suggesting a link between Mgen and female infertility. 36 A prospective United Kingdom study identified several risk factors including age younger than 21 years, black ethnicity, smoking, 2 or more sexual partners in the previous year, and concurrent infection with bacterial vaginosis. 37 A 2011 literature review (48 published reports worldwide) estimated Mgen prevalence at 7.3% in high-risk groups and 2.0% in lowrisk populations.…”