Mycoplasma Genitalium Among Women With Nongonococcal, Nonchlamydial Pelvic Inflammatory Disease

Infectious Diseases in Obstetrics and Gynecology Vol. 2006 Open Access publication by Hindawi Publishing Corporation

Clinical StudyPelvic inflammatory disease (PID) is a frequent condition of young women, often resulting in reproductive morbidity. Although Neisseria gonorrhoeae and/or Chlamydia trachomatis are/is recovered from approximately a third to a half of women with PID, the etiologic agent is often unidentified. We need PCR to test for M genitalium among a pilot sample of 50 women with nongonococcal, nonchlamydial endometritis enrolled in the PID evaluation and clinical health (PEACH) study. All participants had pelvic pain, pelvic organ tenderness, and leukorrhea, mucopurulent cervicitis, or untreated cervicitis. Endometritis was defined as ≥5 surface epithelium neutrophils per ×400 field absent of menstrual endometrium and/or ≥2 stromal plasma cells per ×120 field. We detected M genitalium in 7 (14%) of the women tested: 6 (12%) in cervical specimens and 4 (8%) in endometrial specimens. We conclude that M genitalium is prevalent in the endometrium of women with nongonococcal, nonchlamydial PID.

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[1] J G Tully, D Taylor-Robinson, R M Cole, and D L Rose, “A newly discovered mycoplasma in the human urogenital tract,” Lancet, vol. 1, no. 8233, pp. 1288–1291, 1981. [View at Publisher] [View at Google Scholar]

[2] H Carlberg, E Bjornelius, and J S Jensen, “Mycoplasma genitalium-the search for effective treatment,” International Journal of STD & AIDS, pp. 13–30, 2002.

[3] P A Totten, M A Schwartz, and K E Sjostrom, et al., “Association of Mycoplasma genitalium with nongonococcal urethritis in heterosexual men,” The Journal of Infectious Diseases, vol. 183, no. 2, pp. 269–276, 2001. [View at Publisher] [View at Google Scholar]

[4] S Maeda, M Tamaki, M Nakano, M Uno, T Deguchi, and Y Kawada, “Detection of Mycoplasma genitalium in patients with urethritis,” The Journal of Urology, vol. 159, no. 2, pp. 405–407, 1998. [View at Publisher] [View at Google Scholar]

[5] J S Jensen, “Mycoplasma genitalium: a cause of non-gonococcal urethritis?,” Genitourinary Medicine, vol. 70, no. 5, p. 363, 1994.

[6] D Taylor-Robinson, P M Furr, and N F Hanna, “Microbiological and serological study of non-gonococcal urethritis with special reference to Mycoplasma genitalium,” Genitourinary Medicine, vol. 61, no. 5, pp. 319–324, 1985.

[7] M Janier, F Lassau, and I Casin, et al., “Male urethritis with and without discharge: a clinical and microbiological study,” Sexually Transmitted Diseases, vol. 22, no. 4, pp. 244–252, 1995. [View at Publisher] [View at Google Scholar]

[8] L Mena, X Wang, T F Mroczkowski, and D H Martin, “Mycoplasma genitalium infections in asymptomatic men and men with urethritis attending a sexually transmitted diseases clinic in New Orleans,” Clinical Infectious Diseases, vol. 35, no. 10, pp. 1167–1173, 2002. [View at Publisher] [View at Google Scholar]

[9] P Horner, B Thomas, C B Gilroy, M Egger, and D Taylor-Robinson, “Role of Mycoplasma genitalium and Ureaplasma urealyticum in acute and chronic nongonococcal urethritis,” Clinical Infectious Diseases, vol. 32, no. 7, pp. 995–1003, 2001. [View at Publisher] [View at Google Scholar]

[10] D Gambini, I Decleva, L Lupica, M Ghislanzoni, M Cusini, and E Alessi, “Mycoplasma genitalium in males with nongonococcal urethritis: prevalence and clinical efficacy of eradication,” Sexually Transmitted Diseases, vol. 27, no. 4, pp. 226–229, 2000. [View at Publisher] [View at Google Scholar]

[11] P J Horner, C B Gilroy, B J Thomas, R O Naidoo, and D Taylor-Robinson, “Association of Mycoplasma genitalium with acute non-gonococcal urethritis,” Lancet, vol. 342, no. 8871, pp. 582–585, 1993. [View at Publisher] [View at Google Scholar]

[12] D Taylor-Robinson, J S Jensen, G Fehler, F Radebe, and R C Ballard, “Observations on the microbiology of urethritis in black South African men,” International Journal of STD & AIDS, vol. 13, no. 5, pp. 323–325, 2002.

[13] P J Horner, B Thomas, C B Gilroy, M Egger, and D Taylor-Robinson, “Do all men attending departments of genitourinary medicine need to be screened for non-gonococcal urethritis?,” International Journal of STD & AIDS, vol. 13, pp. 667–673, 2002.

[14] P Morency, M J Dubois, and G Gresenguet, et al., “Aetiology of urethral discharge in Bangui, Central African Republic,” Sexually Transmitted Infections, vol. 77, no. 2, pp. 125–129, 2001. [View at Publisher] [View at Google Scholar]

[15] F E Keane, B J Thomas, C B Gilroy, A Renton, and D Taylor-Robinson, “The association of Chlamydia trachomatis and Mycoplasma genitalium with non-gonococcal urethritis: observations on heterosexual men and their female partners,” International Journal of STD & AIDS, vol. 11, no. 7, pp. 435–439, 2000.

[16] E Bjornelius, P Lidbrink, and J S Jensen, “Mycoplasma genitalium in non-gonococcal urethritis-a study in Swedish male STD patients,” International Journal of STD & AIDS, vol. 11, no. 5, pp. 292–296, 2000.

[17] G Johannisson, Y Enstrom, and G Lowhagen, et al., “Occurrence and treatment of Mycoplasma genitalium in patients visiting STD clinics in Sweden,” International Journal of STD & AIDS, vol. 11, no. 5, pp. 324–326, 2000.

[18] F Busolo, D Camposampiero, G Bordignon, and G Bertollo, “Detection of Mycoplasma genitalium and Chlamydia trachomatis DNAs in male patients with urethritis using the polymerase chain reaction,” The New Microbiologica, vol. 20, no. 4, pp. 325–332, 1997.

[19] M Uno, T Deguchi, and H Komeda, et al., “Mycoplasma genitalium in the cervices of Japanese women,” Sexually Transmitted Diseases, vol. 24, no. 5, pp. 284–286, 1997. [View at Publisher] [View at Google Scholar]

[20] L E Manhart, C W Critchlow, and K K Holmes, et al., “Mucopurulent cervicitis and Mycoplasma genitalium,” The Journal of Infectious Diseases, vol. 187, no. 4, pp. 650–657, 2003. [View at Publisher] [View at Google Scholar]

[21] L Falk, H Fredlund, and J S Jensen, “Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection,” Sexually Transmitted Infections, vol. 81, pp. 73–78, 2005. [View at Publisher] [View at Google Scholar]

[22] J Pepin, A C Labbe, and N Khonde, et al., “Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers,” Sexually Transmitted Infections, vol. 81, no. 1, pp. 67–72, 2005. [View at Publisher] [View at Google Scholar]

[23] L Westrom, “Effect of acute pelvic inflammatory disease on fertility,” American Journal of Obstetrics & Gynecology, vol. 121, no. 5, pp. 707–713, 1975.

[24] B R Moller, D Taylor-Robinson, and P M Furr, “Serological evidence implicating Mycoplasma genitalium in pelvic inflammatory disease,” Lancet, vol. 1, no. 8386, pp. 1102–1103, 1984. [View at Publisher] [View at Google Scholar]

[25] K Lind and G B Kristensen, “Significance of antibodies to Mycoplasma genitalium in salpingitis,” European Journal of Clinical Microbiology, vol. 6, no. 2, pp. 205–207, 1987. [View at Publisher] [View at Google Scholar]

[26] I Simms, K Eastick, and H Mallinson, et al., “Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease,” Sexually Transmitted Infections, vol. 79, no. 2, pp. 154–156, 2003. [View at Publisher] [View at Google Scholar]

[27] C R Cohen, L E Manhart, and E A Bukusi, et al., “Association between Mycoplasma genitalium and acute endometritis,” Lancet, vol. 359, no. 9308, pp. 765–766, 2002. [View at Publisher] [View at Google Scholar]

[28] R B Ness, S L Hillier, and H E Richter, et al., “Douching in relation to bacterial vaginosis, lactobacilli, and facultative bacteria in the vagina,” Obstetrics & Gynecology, vol. 100, no. 4, p. 765, 2002.

[29] I Simms, H Mallinson, and R W Peeling, et al., “Risk factors associated with pelvic inflammatory disease: a UK study,” International Journal of STD & AIDS, vol. 13, p. 18, 2002.

[30] S L Hillier, N B Kiviat, and S E Hawes, et al., “Role of bacterial vaginosis-associated microorganisms in endometritis,” American Journal of Obstetrics & Gynecology, vol. 175, no. 2, pp. 435–441, 1996.

[31] N B Kiviat, P Wolner-Hanssen, and D A Eschenbach, et al., “Endometrial histopathology in patients with culture-proved upper genital tract infection and laparoscopically diagnosed acute salpingitis,” The American Journal of Surgical Pathology, vol. 14, no. 2, pp. 167–175, 1990. [View at Publisher] [View at Google Scholar]

[32] W R Crombleholme, J Schachter, M Ohm-Smith, J Luft, R Whidden, and R L Sweet, “Efficacy of single-agent therapy for the treatment of acute pelvic inflammatory disease with ciprofloxacin,” The American Journal of Medicine, vol. 87, no. 5A, pp. 142S–147S, 1989. [View at Publisher] [View at Google Scholar]

[33] G R Monif, S L Welkos, H Baer, and R J Thompson, “Cul-de-sac isolates from patients with endometritis-salpingitis-peritonitis and gonococcal endocervicitis,” American Journal of Obstetrics & Gynecology, vol. 126, no. 2, pp. 158–161, 1976.

[34] R L Sweet, D L Draper, J Schachter, W K Hadley, and G F Brooks, “Microbiology and pathogenesis of acute salpingitis as determined by laparoscopy: what is the appropriate site to sample?,” American Journal of Obstetrics & Gynecology, vol. 138, no. 7 pt 2, pp. 985–989, 1980.

[35] S E III Thompson, W D Hager, and K H Wong, et al., “The microbiology and therapy of acute pelvic inflammatory disease in hospitalized patients,” American Journal of Obstetrics & Gynecology, vol. 136, no. 2, pp. 179–186, 1980.

[36] R L Sweet, J Mills, and K W Hadley, et al., “Use of laparoscopy to determine the microbiologic etiology of acute salpingitis,” American Journal of Obstetrics & Gynecology, vol. 134, no. 1, pp. 68–74, 1979.

[37] N B Kiviat, P Wolner-Hanssen, and M Peterson, et al., “Localization of Chlamydia trachomatis infection by direct immunofluorescence and culture in pelvic inflammatory disease,” American Journal of Obstetrics & Gynecology, vol. 154, no. 4, pp. 865–873, 1986.

[38] D A Eschenbach, T M Buchanan, and H M Pollock, et al., “Polymicrobial etiology of acute pelvic inflammatory disease,” The New England Journal of Medicine, vol. 293, no. 4, pp. 166–171, 1975.

[39] R C Brunham, B Binns, and F Guijon, et al., “Etiology and outcome of acute pelvic inflammatory disease,” The Journal of Infectious Disease, vol. 158, no. 3, pp. 510–517, 1988.

[40] P K Heinonen, K Teisala, R Punnonen, A Miettinen, M Lehtinen, and J Paavonen, “Anatomic sites of upper genital tract infection,” Obstetrics & Gynecology, vol. 66, no. 3, pp. 384–390, 1985.

[41] F G Cunningham, J C Hauth, L C Gilstrap, W N Herbert, and S S Kappus, “The bacterial pathogenesis of acute pelvic inflammatory disease,” Obstetrics & Gynecology, vol. 52, no. 2, pp. 161–164, 1978.

[42] J Lip and X Burgoyne, “Cervical and peritoneal bacterial flora associated with salpingitis,” Obstetrics & Gynecology, vol. 28, no. 4, pp. 561–563, 1966.

[43] D E Soper, N J Brockwell, H P Dalton, and D Johnson, “Observations concerning the microbial etiology of acute salpingitis,” American Journal of Obstetrics & Gynecology, vol. 170, no. 4, pp. 1008–1014; discussion 1014–1017, 1994.

[44] J N Wasserheit, T A Bell, and N B Kiviat, et al., “Microbial causes of proven pelvic inflammatory disease and efficacy of clindamycin and tobramycin,” Annals of Internal Medicine, vol. 104, no. 2, pp. 187–193, 1986.

[45] J Paavonen, K Teisala, and P K Heinonen, et al., “Microbiological and histopathological findings in acute pelvic inflammatory disease,” British Journal of Obstetrics & Gynaecology, vol. 94, no. 5, pp. 454–460, 1987.

[46] S Hong, C Xin, and Y Qianhong, et al., “Pelvic inflammatory disease in the People's Republic of China: aetiology and management,” International Journal of STD & AIDS, vol. 13, no. 8, pp. 568–572, 2002.

[47] J F Peipert, A B Montagno, A S Cooper, and C J Sung, “Bacterial vaginosis as a risk factor for upper genital tract infection,” American Journal of Obstetrics & Gynecology, vol. 177, pp. 1184–1187, 1997.

[48] A Gogate, “Mycoplasmal pelvic inflammatory disease,” in Recent Advances in Mycoplasmology. Proceedings of the 7th Congress of the International Organization for Mycoplasmology, G Stanek, G H Cassell, J G Tully, and R F Whitcomb, Eds., pp. 239–241, Baden near Vienna, Austria, June 1988.

[49] A P Korn, G Bolan, N Padian, M Ohm-Smith, J Schachter, and D V Landers, “Plasma cell endometritis in women with symptomatic bacterial vaginosis,” Obstetrics & Gynecology, vol. 85, no. 3, pp. 387–390, 1995.

[50] D A Eschenbach, S Hillier, C Critchlow, C Stevens, T DeRouen, and K K Holmes, “Diagnosis and clinical manifestations of bacterial vaginosis,” American Journal of Obstetrics & Gynecology, vol. 158, no. 4, pp. 819–828, 1988.

[51] C L Haggerty, S L Hillier, D C Bass, and R B Ness, “Bacterial vaginosis and anaerobic bacteria are associated with endometritis,” Clinical Infectious Diseases, vol. 39, no. 7, pp. 990–995, 2004. [View at Publisher] [View at Google Scholar]

[52] B R Moller, D Taylor-Robinson, P M Furr, and E A Freundt, “Acute upper genital-tract disease in female monkeys provoked experimentally by Mycoplasma genitalium,” British Journal of Experimental Pathology, vol. 66, no. 4, pp. 417–426, 1985.

[53] D Taylor-Robinson, P M Furr, J G Tully, M F Barile, and B R Moller, “Animal models of Mycoplasma genitalium urogenital infection,” Israel Journal of Medical Sciences, vol. 23, no. 6, pp. 561–564, 1987.

[54] A M Collier, J L Carson, P C Hu, S S Hu, C H Huang, and M F Barile, “Attachment of Mycoplasma genitalium to the ciliated epithelium of human Fallopian tubes,” in Recent Advances in Mycoplasmology. Proceedings of the 7th Congress of the International Organization for Mycoplasmology, G Stanek, G H Cassell, J G Tully, and R F Whitcomb, Eds., pp. 730–732, Baden near Vienna, Austria, June 1988.

[55] C R Cohen, N R Mugo, and S G Astete, et al., “Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis,” Sexually Transmitted Infections, vol. 81, no. 6, pp. 463–466, 2005. [View at Publisher] [View at Google Scholar]

[56] H F Svenstrup, J Fedder, J Abraham-Peskir, S Birkelund, and G Christiansen, “Mycoplasma genitalium attaches to human spermatozoa,” Human Reproduction, vol. 18, no. 10, pp. 2103–2109, 2003. [View at Publisher] [View at Google Scholar]

[57] R B Ness, D E Soper, and J Peipert, et al., “Design of the PID evaluation and clinical health (PEACH) study,” Controlled Clinical Trials, vol. 19, no. 5, pp. 499–514, 1998. [View at Publisher] [View at Google Scholar]

[58] R B Ness, D E Soper, and R L Holley, et al., “Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) randomized trial,” American Journal of Obstetrics & Gynecology, vol. 186, no. 5, pp. 929–937, 2002.

[59] C L Haggerty, R B Ness, and A Amortegui, et al., “Endometritis does not predict reproductive morbidity after pelvic inflammatory disease,” American Journal of Obstetrics & Gynecology, vol. 188, no. 1, pp. 141–148, 2003.

[60] D Taylor-Robinson, “Mycoplasma genitalium-an up-date,” International Journal of STD & AIDS, vol. 13, no. 3, pp. 145–151, 2002.

[61] H F Clausen, J Fedder, and M Drasbek, et al., “Serological investigation of Mycoplasma genitalium in infertile women,” Human Reproduction, vol. 16, no. 9, pp. 1866–1874, 2001. [View at Publisher] [View at Google Scholar]

[62] P CT Hannan, “Comparative susceptibilities of various AIDS-associated and human urogenital tract mycoplasmas and strains of Mycoplasma pneumoniae to 10 classes of antimicrobial agent in vitro,” Journal of Medical Microbiology, vol. 47, no. 12, pp. 1115–1122, 1998.

[63] R Hamasuna, Y Osada, and J S Jensen, “New antibiotic susceptibility test of Mycoplasma genitalium by using Real-Time PCR,” in Program and Book of Abstracts, 16th Biennial Meeting of the International Society for Sexually Transmitted Diseases Research (ISSTDR), p. 303, Amsterdam, The Netherlands, July 2005.

Catherine L. Haggerty, Patricia A. Totten, Sabina G. Astete, and Roberta B. Ness, “Mycoplasma Genitalium Among Women With Nongonococcal, Nonchlamydial Pelvic Inflammatory Disease,” Infectious Diseases in Obstetrics and Gynecology, vol. 2006, Article ID 30184, 5 pages, 2006. doi:10.1155/IDOG/2006/30184

@article{30184,

author = {Haggerty, Catherine L. and Totten, Patricia A. and Astete, Sabina G. and Ness, Roberta B.},

title = {Mycoplasma Genitalium Among Women With Nongonococcal, Nonchlamydial Pelvic Inflammatory Disease},

journal = {Infectious Diseases in Obstetrics and Gynecology},

year = {2006},

volume = {2006},

pages = {Article ID 30184, 5 pages},

note = {doi:10.1155/IDOG/2006/30184}