Mycoplasma genitalium and Trichomonas vaginalis: addressing disparities and promoting public health control of two emerging sexually transmitted infections

Abstract

Purpose of review Mycoplasma genitalium (M. genitalium) and Trichomonas vaginalis (T. vaginalis), sexually transmitted infections that remain non-reportable in the United States, may lead to pelvic inflammatory disease (PID) and adverse pregnancy outcomes if left untreated. Prevalence estimates have highlighted socioeconomic and racial/ethnic disparities in rates of infection. This review summarizes the recent literature on M. genitalium and T. vaginalis with a focus on the epidemiology, screening, and treatment of M. genitalium and T. vaginalis. Recent findings The burden of T. vaginalis testing remains on women. Antimicrobial resistance is of great concern for M. genitalium. Comprehensive screening and treatment guidelines present an opportunity to address these public health concerns. Summary M. genitalium and T. vaginalis infections disproportionately affect sexual and racial/ethnic minorities and those facing socioeconomic disparities. The availability of nucleic acid amplification test testing has facilitated accurate diagnosis of both disorders. Safe and efficacious treatments are available for treatment of both disorders. Integrating macrolide resistance testing into treatment algorithms for M. genitalium and dual antibiotic therapy may prove a useful strategy for future US-based guidance. Public health reporting and increased public awareness campaigns are key next steps to addressing the observed reproductive health disparities.

Maternal and Fetal Outcomes in an Observational Cohort of Women With Mycoplasma genitalium Infections

“…Women with MG diagnoses tend to be different from women in the general population, including diagnosis with other STIs. 4 Given that so few women have coinfections, it is difficult to determine the effects of specific infections among those with multiple diagnosed STI.…”

“…High-risk populations have been identified among younger women and racial/ethnic minorities with elevated STI risk. In particular, African American populations have been shown to have a higher prevalence of MG, as high as 22% 4 …”

“…In particular, African American populations have been shown to have a higher prevalence of MG, as high as 22%. 4 Both women and men tend to be asymptomatic with MG infection, although urethritis has been associated with MG infection among men. 5 Among women, MG infection has been associated with urethritis and cervicitis, 6 pelvic inflammatory disease (PID), and endometritis, as well as infertility.…”

Point-of-Care Amenable Detection of Mycoplasma genitalium and Its Antibiotic Resistance Mutations

“…Due to its fastidious and slow-growing nature, MG is also difficult to detect through traditional culture-based methods . As such, detection of MG is achieved through nucleic acid amplification testing (NAAT), and since 2019 the U.S. Food and Drug Administration (FDA) has cleared two MG diagnostic NAAT assays. − But even with the approval of the NAAT assays, identification of MG is not yet widely available and reportable …”

“…9−11 But even with the approval of the NAAT assays, identification of MG is not yet widely available and reportable. 4 Of more significant concern is that MG has developed resistance to multiple classes of antibiotics, 5 rendering several treatments ineffective. Some antibiotic resistance in MG has resulted from protein dysfunction and is linked to specific genetic mutations.…”