A cross-sectional study in the journal Sexually Transmitted Infections has found that Mycoplasma genitalium (MG) is just as prevalent as Chlamydia trachomatis (CT) among women seen at a sexual health center in Australia.
“While the contribution of MG to symptoms in men is well described, less is known about its association with common genital symptoms in women,” wrote the authors.
The study comprised 1318 women who attended the Melbourne Sexual Health Centre (MSHC) between April 2017 and April 2019.
The 3 most frequently self-reported symptoms on a questionnaire were abnormal vaginal discharge (34%), abnormal vaginal odor (24%), and vulvovaginal itch (21%).
Compared with asymptomatic women, symptomatic women were nearly twice as likely to report inconsistent condom use in the prior 12 months and nearly 2.5 times more likely to have had a sexually transmitted infection (STI) in the past 6 months.
Participants were tested for MG and macrolide resistance, CT, Neisseria gonorrhoeae (NG), Trichomonas vaginalis, bacterial vaginosis (BV), and vulvovaginal candidiasis (VVC).
Among the entire cohort, 6% (n = 83) had MG, of whom 48% (n = 39) had macrolide-resistant MG. Similarly, 8% (n = 103) had CT. The incidence of MG was comparable in asymptomatic and symptomatic women: 5% (10 of 195) and 7% (73 of 1108), respectively (P = .506).
However, MG was 4.38 times more likely to be associated with mucopurulent cervicitis on examination (P = .002). But MG was not linked to other specific genital symptoms or signs.
“These data provide evidence that routine testing for MG in women with common genital symptoms is not indicated,” the authors wrote.
BV and VVC were the only infections detected more frequently in symptomatic women than in asymptomatic women: 33% vs 17% for BV (P < .001) and 26% vs 15% for VVC (P = .001), respectively.
This finding reflects how frequent the symptoms of vaginal discharge, odor, and itch were in female STI clinic attendees. All women with MG were symptomatic.
One challenge in treating MG is increasing antimicrobial resistance. Recent Australian studies have found that 50% to 60% of MG infections in heterosexuals are macrolide resistant, with resistance exceeding 80% in men who have sex with men.
Treatment strategies for MG also are more complex and costly. Nonetheless, up to 50% of women patients at MSHC can avoid quinolone therapy, while attaining 95% first-line cure with a doxycycline-2.5 g azithromycin regimen.
Because recruitment for the study was limited to a single sexual health clinic and non–English-speaking women were excluded, prevalence estimates are not generalizable.
The investigators also were unable to approach all women attending the clinic because only select doctors recruited symptomatic women. In addition, women with marked pelvic inflammatory disease (PID) were not recruited in order to expedite clinical care.
Therefore, the study did not assess the connection between MG and PID, thus probably resulting in more women with milder symptoms.
Furthermore, vaginal symptoms are less likely to be linked to cervical STIs, which may have affected the authors’ ability to evaluate associations between other relevant symptoms and signs.
“As a consequence, our findings are most relevant to women with mild to moderate genitourinary symptoms attending outpatient STI services and general practices,” they wrote.