M. genitalium infection associated with higher risk for pelvic inflammatory disease

Mycoplasma genitalium appears to be closely associated with risk for pelvic inflammatory disease, according to a recent study.

Researchers performed a systematic review and meta-analysis of studies that used established clinical criteria to assess women for pelvic inflammatory disease and nucleic acid amplification tests to detect M. genitalium. The goal was to determine the association between M. genitalium and pelvic inflammatory disease, as well as M. genitalium positivity among pelvic inflammatory disease cases. The results were published June 7 by Clinical Infectious Diseases.

Nineteen studies published between 2002 and 2022 were included. Ten studies estimated the association of M. genitalium with pelvic inflammatory disease, and all 19 estimated M. genitalium positivity in pelvic inflammatory disease cases. Four were case-control studies, seven were cross-sectional studies, two were prospective studies, four were retrospective studies, and two were randomized controlled trials. The pooled sample size was 21,104 women, with an age range of 13 to 67 years.

Infection with M. genitalium infection was significantly associated with pelvic inflammatory disease, with a pooled odds ratio of 1.67 (95% CI, 1.24 to 2.24). The pooled positivity of M. genitalium in cases of pelvic inflammatory disease was 10.3% (95% CI, 5.63% to 15.99%). In subgroup and meta-regression analyses, M. genitalium positivity in cases of pelvic inflammatory disease was highest in North, Central, and South America, in studies done in both inpatient and outpatient clinic settings, and in populations who were at high risk for sexually transmitted infections.

The researchers noted that most of the data came from high-income countries and that there was substantial heterogeneity in the pooled estimate of M. genitalium positivity among women with pelvic inflammatory disease, among other limitations. They concluded that M. genitalium is associated with a 67% increase in odds of pelvic inflammatory disease and that it is detected in approximately one in 10 pelvic inflammatory disease diagnoses.

"As international studies are reporting a decline in the proportion of PID [pelvic inflammatory disease] cases attributed to traditional pathogens such as chlamydia and gonorrhoea, clinicians need to be aware that M. genitalium is a cause of PID and is not uncommon," they wrote. "Failure to respond to empiric treatment should at the very least alert clinicians to the need to test for M. genitalium, and where resources allow testing for chlamydia and gonorrhoea at initial PID diagnosis, M. genitalium should also be included, as is currently recommended by a number of guidelines."