Mycoplasma genitalium Infection Is Associated with Microscopic Signs of Cervical Inflammation in Liquid Cytology Specimens

Abstract

Cervicitis is a common clinical finding often attributed to sexually transmitted infections (STIs), but no etiologic agent is identified in the majority of cases. In this study, we comparatively assessed inflammation among the common infectious etiologies of cervicitis and assessed the potential value of liquid cytology specimens for predicting STIs. Among 473 Louisiana women at low risk for acquiring STIs, the prevalences of Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis in liquid-based cytology specimens were 1.5, 2.1, 0.6, and 4.4%, respectively. N. gonorrhoeae and human papillomavirus 18 (HPV18) infections were significantly more common among subjects infected with M. genitalium. Using direct microscopy, we observed significant increases in leukocyte infiltrates among subjects with monoinfections with M. genitalium or C. trachomatis compared to women with no detectable STIs. Inflammation was highest among subjects with M. genitalium. Using a threshold of >2 leukocytes per epithelial cell per high-powered field, the positive predictive values for M. genitalium, C. trachomatis, N. gonorrhoeae, and T. vaginalis were 100, 70, 67, and 20%, respectively. Several novel M. genitalium genotypes were identified, all of which were predicted to be susceptible to macrolide antibiotics, suggesting that different strains may circulate among low-risk women and that macrolide resistance is substantially lower than in high-risk populations. This study highlights the capacity of M. genitalium to elicit cervical inflammation and, considering the strong epidemiologic associations between M. genitalium and human immunodeficiency virus (HIV), provides a potential mechanism for acquisition and shedding of HIV via chronic leukocyte recruitment to the cervical mucosa.

Cervical Cytology of Samples with Ureaplasma urealyticum, Ureaplasma parvum, Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma hominis, and Neisseria gonorrhoeae Detected by Multiplex PCR

“…To the best of our knowledge, there is a lack of well-defined criteria for cervicitis on pap smears and, even more so, for pathogen prediction. In a previous study with liquid-based preparations, the authors concluded that using a threshold of ≥2 leukocytes per epithelial cell per high-powered field, the positive predictive values for Mycoplasma genitalium, Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were 100, 70, 67, and 20%, respectively [16]. The low threshold used in this previous study would explain the low positive predictive value of the method for Trichomonas vaginalis which usually causes intense inflammatory exudate.…”

A Case–control Study on the Relationship between Mycoplasma genitalium Infection in Women with Normal Pregnancy and Spontaneous Abortion using Polymerase Chain Reaction

“…Dehon and McGowin [15], using real-time quantitative PCR reported that in 473 women with a low risk for acquiring STDs, the prevalence rate of M. genitalium was 1.5%. In our study, in patient and control groups, 10.09% and 4.58% of women had vaginal infections, respectively.…”

A novel whole-bacterial enzyme linked-immunosorbant assay to quantify Chlamydia trachomatis specific antibodies reveals distinct differences between systemic and genital compartments

“…gonorrhoeae infections were tested for by the presence of rRNA using GENPROBE® APTIMA® as instructed by the manufacturer, while T . vaginalis infection was determined by wet mount and real time PCR [ 73 , 74 ]. Fifty percent of the recruited women had bacterial vaginosis, defined by a Nugent score of 7 or higher [ 75 ].…”