Mycoplasma genitalium is associated with numerous human genitourinary tract maladies, including nonchlamydial, nongonococcal urethritis in men and cervicitis, endometritis, and pelvic inflammatory disease in women (1,4,5,12,19,29,30,35,39). Understanding the epidemiological aspects of infections and developing effective treatment require reliable typing of pathogenic microorganisms. Since M. genitalium is very difficult to culture from clinical specimens (13, 21), classical microbiological typing methods are not readily applicable. Furthermore, serological approaches are not widely used because of cross-reactivity with other mycoplasmas, especially with Mycoplasma pneumoniae (15,26). Therefore, typing of M. genitalium strains relies on DNA sequence data. Recently, sequence variability of the rRNA operon and tandem repeats in the MG309 locus have been evaluated with clinical specimens (28). However, the majority of M. genitalium clinical sequence data available today is based upon the gene mgpB (locus MG191 of sequenced reference strain G37 [11]) encoding the M. genitalium adhesin MgPa (14,17,21). An M. genitaliumspecific diagnostic PCR assay was designed to target the proximal unique region of this gene (using primers MgPa-1 and MgPa-3 [22] and designated here "MgPa-13"). The MgPa-13 region has exhibited sequence stability in persistently infected patients for up to 21 months (17). Despite this intrastrain stability, high levels of sequence variability between clinical isolates were observed (14, 17). Based on this sequence region, transmission of M. genitalium between sexual partners was shown, as was colonization of different anatomical sites of the same patient by identical strains (14).Here, we present analysis of MgPa-13 sequences generated from clinical specimens collected at the Project S.A.F.E. sexually transmitted disease (STD) clinic in San Antonio, TX (36), from recruited female participants and their male partners. Alignment of MgPa-13 sequences corroborated transmission between partners and colonization of different anatomical sites by the same strain. Comparison of newly recovered sequences with all currently available clinical data (14, 17, 21) revealed not only the presence of several common variants but also distinct sequences. Analyses of encoded amino acids uncovered mutations that determine common features among MgPa-13 region variants.
MATERIALS AND METHODSOrigin and processing of clinical specimens. A group of minority women (Mexican and African American) and their partners were recruited from public health clinics throughout San Antonio, TX, into a controlled randomized trial of behavioral-cognitive interventions to reduce the recurrence of STDs (36). Women were recruited into the study after being diagnosed with a nonviral STD, specifically infection with Chlamydia trachomatis, Neisseria gonorrheae, Trichomonas vaginalis, or Treponema pallidum. At each clinic visit, urine specimens were obtained from both female and male subjects, and at the same time, vaginal and cervical swab (VC) speci...