The clinical indications for testing women for Mycoplasma genitalium

BackgroundWhile the contribution of Mycoplasma genitalium (MG) to symptoms in men is well described, less is known about its association with common genital symptoms in women. We aimed to determine the prevalence of MG and macrolide resistance, and its association with common genital symptoms in women attending a sexual health service, to inform indications for testing and clinical practice.MethodsWe undertook a cross-sectional study of symptomatic and asymptomatic women attending Melbourne Sexual Health Centre (MSHC), between April 2017 and April 2019. Women were tested for MG and macrolide resistance, Chlamydia trachomatis (CT), Neisseria gonorrhoeae, Trichomonas vaginalis, bacterial vaginosis and vulvovaginal candidiasis. Women completed a questionnaire on symptoms, and symptomatic women underwent examination. The prevalence of MG (and macrolide resistance) and other genital infections was calculated with 95% CIs, and associations between these outcomes and specific genital symptoms were examined using logistic regression.ResultsOf 1318 women, 83 (6%, 95% CI: 5% to 8%) had MG, of which 39 (48%, 95% CI: 36% to 59%) had macrolide-resistant MG; 103 (8%, 95% CI: 6% to 9%) women had CT. MG prevalence was similar in asymptomatic (10 of 195; 5%) and symptomatic (73 of 1108; 7%) women, p=0.506. MG was associated with mucopurulent cervicitis on examination (adjusted OR=4.38, 95% CI: 1.69 to 11.33, p=0.002), but was not associated with other specific genital symptoms or signs.ConclusionsMG was as common as CT among women attending MSHC. MG was not associated with genital symptoms, but like CT, was significantly associated with cervicitis. These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated. The presence of macrolide resistance in 48% of women supports use of resistance-guided therapy.

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Prevalence of rectal Mycoplasma genitalium and macrolide resistance in men who have sex with men attending Sydney Sexual Health Centre

Sexual Health ◽

10.1071/sh18221 ◽

2020 ◽

Vol 17 (2) ◽

pp. 114

Author(s):

Isabella Bradley ◽

Rick Varma ◽

Vickie Knight ◽

Dimitra Iliakis ◽

Leon McNally ◽

...

Keyword(s):

Multivariate Analysis ◽

Sexual Health ◽

Rectal Swab ◽

Health Centre ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Cross Sectional ◽

Screening Guidelines ◽

Sexually Transmissible Infections ◽

Sex With Men

Background Sexually transmissible infections (STIs) have been increasing in men who have sex with men (MSM) in recent years; however, few studies have investigated the prevalence or antimicrobial resistance in rectal Mycoplasma genitalium in this group. This study aimed to determine the prevalence and predictors of rectal M. genitalium in MSM attending an urban sexual health service in Sydney, Australia, namely the Sydney Sexual Health Centre (SSHC), as well as estimate the rate of macrolide resistance. Methods: A prospective cross-sectional analysis was conducted of rectally asymptomatic MSM having a rectal swab collected as part of their routine care. Participants self-collected a rectal swab to be tested for M. genitalium and completed a 14-item questionnaire that provided information on behavioural risk factors. The prevalence of rectal M. genitalium was determined and multivariate analysis was performed to assess the associations for this infection. Positive specimens then underwent testing for macrolide-resistant mutations (MRMs) using the ResistancePlus MG assay (SpeeDx, Eveleigh, NSW, Australia). Results: In all, 742 patients were consecutively enrolled in the study. The median age was 31 years (interquartile range 27–39 years), with 43.0% born in Australia. Overall, 19.0% of men were bisexual, 22.9% were taking pre-exposure prophylaxis (PrEP) and 4.3% were HIV positive. The prevalence of rectal M. genitalium was 7.0% (95% confidence interval (CI) 5.3–9.1) overall and 11.8% in those taking PrEP. On multivariate analysis, PrEP use was significantly associated with having rectal M. genitalium (odds ratio 2.01; 95% CI 1.09–3.73; P = 0.01). MRMs were detected in 75.0% (36/48; 95% CI 60.4–86.4%) of infections. Conclusion: Rates of rectal M. genitalium infection were high among asymptomatic MSM attending SSHC and MRMs were detected in 75% of infections. PrEP use was found to be significantly associated with rectal M. genitalium infection. These data contribute to the evidence base for screening guidelines in MSM.

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Cervicitis: limited clinical utility for the detection of Mycoplasma genitalium in a cross-sectional study of women attending a New Zealand sexual health clinic

Sexual Health ◽

10.1071/sh12168 ◽

2013 ◽

Vol 10 (3) ◽

pp. 263 ◽

Cited By ~ 8

Author(s):

Jeannie Oliphant ◽

Sunita Azariah

Keyword(s):

Sexual Health ◽

Trichomonas Vaginalis ◽

Clinical Utility ◽

Clinical Symptoms ◽

Mycoplasma Genitalium ◽

Cross Sectional Study ◽

Health Clinic ◽

Sectional Study ◽

Cross Sectional ◽

Sexually Transmissible Infections

Background Although multiple studies have confirmed Mycoplasma genitalium as a cause of nongonococcal urethritis in men, there is less evidence of its pathogenicity in women. Our aims were to determine the prevalence of M. genitalium in a sample of women attending a sexual health clinic and to assess whether there was any association between the detection of M. genitalium and a diagnosis of cervicitis in this population. Methods: A cross-sectional study recruited women who required screening for sexually transmissible infections. Endocervical swabs to detect the presence of M. genitalium were taken in addition to routine testing for Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Data were collected on demographics, sexual behaviour, clinical symptoms and the presence of clinical or microscopic cervicitis. Results: The prevalence of M. genitalium was 8.4% (n = 22, 95% confidence interval (CI): 5.4–12.5%) in the study sample of 261 women. There was an association between the finding of cervical contact bleeding (odds ratio OR): 5.45; 95% CI: 1.93–15.42, P = 0.001) and microscopic cervicitis (OR: 2.64; 95% CI: 0.95–7.34, P = 0.06) and the presence of M. genitalium when compared with women with no diagnosed infection; however, the latter finding was not statistically significant. Conclusions: Although the prevalence of M. genitalium was high at 8.4%, the overall lack of any association between the findings of cervicitis and the detection of M. genitalium support the conclusion that cervicitis has poor clinical utility as an indicator for the presence of M. genitalium infection.

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Clinical presentation of asymptomatic and symptomatic women who tested positive for genital gonorrhoea at a sexual health service in Melbourne, Australia

Epidemiology and Infection ◽

10.1017/s0950268820002265 ◽

2020 ◽

Vol 148 ◽

Cited By ~ 1

Author(s):

Mario Martín-Sánchez ◽

Christopher K. Fairley ◽

Jason J. Ong ◽

Kate Maddaford ◽

Marcus Y. Chen ◽

...

Keyword(s):

Sexual Health ◽

Health Centre ◽

Cross Sectional Study ◽

Nucleic Acid Amplification ◽

Sexual Practices ◽

Cross Sectional ◽

Sexual Health Service ◽

Behavioural Research ◽

The Mean ◽

Mean Time

Abstract Gonorrhoea cases in women have been rising in Australia in the 2010s but the cause of the increase is not well understood. This cross-sectional study aimed to describe the characteristics of genital gonorrhoea infection in women attending the Melbourne Sexual Health Centre, Australia. Gonorrhoea cases were diagnosed by nucleic acid amplification test (NAAT) and/or culture. Genitourinary specimens were obtained in 12 869 clinic visits in women aged 16 years or above between August 2017 and August 2018. Genital gonorrhoea was detected in 142 (1.1%) of the visits. Almost half of the cases were asymptomatic, 47.9% [95% confidence interval (CI) 39.8–56.1%]; yellow, green or pus-like vaginal discharge was present in 11.3% (95% CI 7.0–17.6%) and other genital symptoms in 40.8% (95% CI 33.1–49.1%) of the cases. The mean time between last sexual contact and onset of symptoms was 7.3 days and between the onset of symptoms to presentation to the clinic was 12.1 days. Half of the cases of genital gonorrhoea among women are asymptomatic and these cases would have been missed by testing of only symptomatic women. Further epidemiological and behavioural research is required to understand the temporal changes in sexual practices among women in Australia.

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Resistance-guided treatment of Mycoplasma genitalium infection at a UK sexual health centre

International Journal of STD & AIDS ◽

10.1177/0956462420987764 ◽

2021 ◽

pp. 095646242098776

Author(s):

Ruairi JH Conway ◽

Seamus Cook ◽

Cassandra Malone ◽

Simon Bone ◽

Mohammed Osman Hassan-Ibrahim ◽

...

Keyword(s):

Single Dose ◽

Confidence Interval ◽

Sexual Health ◽

Treatment Failure ◽

Inflammatory Disease ◽

Health Centre ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Fluoroquinolone Resistance ◽

Treatment Failure Rate

We evaluated the ResistancePlus® MG assay in providing macrolide resistance-guided treatment (RGT) for Mycoplasma genitalium infection at a UK sexual health centre. M. genitalium–positive samples from men with urethritis and women with pelvic inflammatory disease (PID) were tested for macrolide resistance–mediating mutations (MRMMs). MRMM-positive infections were given moxifloxacin 400 mg; otherwise 2 g azithromycin (1 g single dose and then 500 mg OD) was given. Among 57 M. genitalium–positive patients (32 men and 25 women), MRMMs were detected in 41/57 (72% [95% confidence interval (95% CI) 58–83%). Thirty-two of 43 patients given RGT attended for test of cure. Treatment failure rate was significantly lower at 1/32 (3%) than 10/37 (27%) before RGT ( n = 37 [men = 23 and women = 17]; p = 0.008). Treatment failure was lower in male urethritis (0/15 vs. 7/21 p = 0.027) but not in female PID. There was a trend of a shorter time to negative test of cure (TOC) in male urethritis (55.1 [95% 43.7–66.4] vs. 85.1 [95% CI CI 64.1–106.0] days, p = 0.077) but not in female PID. Macrolide resistance is higher than previous UK reports and higher than expected. RGT reduces overall treatment failure and is particularly beneficial in M. genitalium urethritis. Fluoroquinolone resistance will continue to rise with increasing fluoroquinolone use, and RGT is critical to direct appropriate azithromycin use and prevent overuse of moxifloxacin.

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Mycoplasma genitalium: test positivity in syndromic presentations and clinicians’ adherence with treatment guidelines at Sydney Sexual Health Centre

International Journal of STD & AIDS ◽

10.1177/09564624211022583 ◽

2021 ◽

pp. 095646242110225

Author(s):

Calvin Cheung ◽

Christopher Bourne ◽

Rick Varma

Keyword(s):

Decision Making ◽

Antimicrobial Resistance ◽

Sexual Health ◽

Treatment Guidelines ◽

Health Centre ◽

Diagnostic Testing ◽

Mycoplasma Genitalium ◽

Macrolide Resistance ◽

Adherence To Treatment ◽

Real World Data

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.

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Chlamydia Detection during the Menstrual Cycle: A Cross-Sectional Study of Women Attending a Sexual Health Service

PLoS ONE ◽

10.1371/journal.pone.0085263 ◽

2014 ◽

Vol 9 (1) ◽

pp. e85263 ◽

Cited By ~ 4

Author(s):

Dana S. Forcey ◽

Jane S. Hocking ◽

Sepehr N. Tabrizi ◽

Catriona S. Bradshaw ◽

Marcus Y. Chen ◽

...

Keyword(s):

Menstrual Cycle ◽

Health Service ◽

Sexual Health ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Sexual Health Service

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Pelvic inflammatory disease associated with Chlamydia trachomatis but not Mycoplasma genitalium in New Zealand

Sexual Health ◽

10.1071/sh14238 ◽

2016 ◽

Vol 13 (1) ◽

pp. 43 ◽

Cited By ~ 2

Author(s):

Jeannie Oliphant ◽

Sunita Azariah

Keyword(s):

New Zealand ◽

Chlamydia Trachomatis ◽

Sexual Health ◽

Pelvic Inflammatory Disease ◽

Inflammatory Disease ◽

Trichomonas Vaginalis ◽

Mycoplasma Genitalium ◽

Control Group ◽

Sexual Health Service ◽

Relevant Variables

Background There is a paucity of studies looking at associations between Mycoplasma genitalium and pelvic inflammatory disease (PID). The objectives of this study were to estimate the prevalence of M. genitalium in women attending a sexual health service in New Zealand and secondly to examine for an association of M. genitalium with PID. Methods: Women consecutively attending the service for a sexual health screen (Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis) were recruited to establish a baseline prevalence of M. genitalium. An extra cervical swab was taken for the detection of M. genitalium. Recruitment of additional women with a clinical diagnosis of PID continued until a sufficient sample size was obtained to examine the association of PID with M. genitalium. Women in the baseline sample without PID were used as the control group. Results: The control group included 250 women, with M. genitalium diagnosed in 8.7% (95% CI 5.8–12.9%) and C. trachomatis in 9.9% (95% CI 6.8–14.2%). Ninety-one women were recruited with PID; M. genitalium was diagnosed in 9.9% (95% CI 5.3–17.7%) and C. trachomatis in 27.5% (95% CI 19.4–37.4%). Multivariate analysis using clinically relevant variables showed that a diagnosis of C. trachomatis (OR 2.44, 95% CI 1.24–4.81) but not M. genitalium (OR 0.91, 95% CI 0.38–2.20) was significantly associated with a PID diagnosis. Conclusions: M. genitalium was almost as commonly diagnosed as C. trachomatis in this population. C. trachomatis was the only infection that was significantly associated with PID.

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Microbiological Characteristics of Chlamydia trachomatis and Neisseria gonorrhoeae Infections in South African Women

Journal of Clinical Microbiology ◽

10.1128/jcm.02848-15 ◽

2015 ◽

Vol 54 (1) ◽

pp. 200-203 ◽

Cited By ~ 12

Author(s):

Jan Henk Dubbink ◽

Dewi J. de Waaij ◽

Myrte Bos ◽

Lisette van der Eem ◽

Cécile Bébéar ◽

...

Keyword(s):

Chlamydia Trachomatis ◽

Neisseria Gonorrhoeae ◽

Trichomonas Vaginalis ◽

Mycoplasma Genitalium ◽

Cross Sectional Study ◽

African Women ◽

Transmitted Infection ◽

Cross Sectional ◽

Content Type ◽

South African Women

We analyzed data of 263 women with at least one genital or anorectal sexually transmitted infection from a cross-sectional study conducted in rural South Africa. We provide new insights concerning the concurrence ofChlamydia trachomatis,Neisseria gonorrhoeae,Mycoplasma genitalium, andTrichomonas vaginalisinfections as well as the characteristics of bacterial loads.

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