A silent epidemic: the prevalence, incidence and persistence of Mycoplasma genitalium among young, asymptomatic high-risk women in the United States

Abstract

Background

Mycoplasma genitalium (MG) is a sexually transmitted infection (STI) that can result in pelvic inflammatory disease and adverse pregnancy outcomes. We analyzed data collected from a prospective study of asymptomatic bacterial vaginosis (BV) to determine the natural history of MG.

Methods

Women aged 15–25 years, with ≥2 STI risk factors and asymptomatic BV were recruited from 10 sites throughout the United States. Vaginal swabs were collected at enrollment, and by home-based testing every 2 months over 12 months. MG nucleic acid amplification testing was performed using transcription-mediated assays (Hologic Inc, California). MG prevalence, incidence and persistence [defined as MG(+) from all follow-up specimens] were estimated with 95% confidence intervals (CI). Adjusted odds ratios (AORs) were calculated using logistic and Poisson regression to evaluate participant characteristics associated with MG infection.

Results

Among 1139 women, 233 were MG(+) for a prevalence of 20.5% (95% CI: 18.2- 22.9); 42/204 were identified with persistent MG (20.6%). Among 801 MG(-) women at baseline with 711.2 person-years of follow-up, MG incidence was 36.6 per 100 person-years (95% CI: 32.4-41.3).  Black race (AOR 1.92, CI: 1.09- 3.38), age ≤ 21 years (AOR 1.40, CI: 1.03-1.91), and history of prior pregnancy (AOR 1.36, CI: 1.00-1.85) were associated with prevalent MG; only Black race was associated with incident MG (p=0.03).

Conclusions

We identified high rates of prevalent, incident, and persistent MG infections among young, high-risk women with asymptomatic BV, supporting the need for clinical trials to evaluate the impact of MG screening on female reproductive health outcomes.