Mycoplasma genitalium : a pathogen that causes inflammatory diseases of the pelvic organs, requiring special attention

Chlamydia trachomatis is the most common causative agent of sexually transmitted infections worldwide and has been a well-studied cause of the development of cervicitis and pelvic inflammatory disease (PID) in women, causing serious consequences, including chronic pelvic pain syndrome, infertility and ectopic pregnancy.

In the United States and European countries, programs aimed at educating, examining and treating the target patient population (adolescent and young girls) have been shown to be effective in preventing the long-term effects of l infection and reduce its prevalence in general. Thus, in regions where programs for the detection and treatment of C. infection have been widely introduced trachomatis, the frequency of PID and ectopic pregnancies has considerably decreased. And this has happened despite the increased frequency of recording chlamydia infections, which may be associated with better diagnosis and the use of tests based on nucleic acid amplification (PCR diagnostics) and examination of a greater number of patients belonging to risk groups. Fortunately, 2 antimicrobials - azithromycin and doxycycline - remain very effective in controlling C. trachomatis.

In many patients with cervicitis and / or examination, no C. trachomatis, nor Neisseria gonorrhoeae. Recent data indicate the need to consider Mycoplasma genitalium as an important cause in these patients, as well as a co-pathogen in individuals who have not responded to doxycycline. Although M. genitalium is a well-known cause of non-gonococcal urethritis in men; contradictory data have been obtained on the role of this microorganism as a responsible pathogen in women with cervicitis and PID. However, the results of a one-stage cross-sectional case-control study by Malmö (Sweden) clearly demonstrated that M. genitalium is an independent and significant risk factor for cervicitis and PID.

For 5 years, Bjartling and colleagues examined 5,519 women who sought outpatient care from a gynecologist with various gynecological symptoms. The age of the patients varied from 15 to 52 years (on average, 26 years). Detection frequency M. genitalium was 2.1%, C. trachomatis - 2.8%, the two pathogens were identified in 3.8% of patients. In younger women, a higher frequency of determining two pathogens at the same time was noted. Most often C. trachomatis has been determined in women aged 15 to 20 years and M. genitalium - in patients aged 20 to 24 years. Cervicitis and PID are more often diagnosed in M. genital positive patients compared to the negative control (cervicitis 22.3% vs 7%, p less than 0.001; PID - 4.9% vs 0.6%, p = 0.01). In women infected with C. trachomatis, the highest incidence of cervicitis (33.4%, p less than 0.001) and PID (18.3%, p less than 0.001) a has been observed in patients infected with M. genitalium.

It is important to note that the infection caused by M. genitalium, led less often to the development of symptoms, and they were less severe than those caused by C. trachomatis. Vaginal discharge, post-coital bleeding and pain during urination were injected more frequently in C. trachomatis positive women compared to M. genital patients positive. In women infected with M. genitalium, the only symptom they noticed more frequently was post-coital bleeding (22.3% vs 11.9%, p = 0.008). Cervical pain, elevated CRP and fever were more common with C. trachomatis than with M. genitalium.

A London study found that among female students who had M. genitalium, there was a statistically insignificant increase in the incidence of symptomatic PID over the next 12 months. Another study in the UK found an independent association M. genitalium with PID in patients with STI clinics. In a large-scale study earlier in the United States, detection of M. genitalium was independently associated with endometritis (odds ratio 3, 95% confidence interval 1.5- 6.1), and there was a statistically unreliable tendency to increase infertility, relapse of PID, and chronic pelvic pain after infection caused by M. genitalium.

Thus, in these studies, it has been shown that although M. genitalium, as a rule, is less likely to cause symptoms, and they are less severe compared to C. trachomatis, this pathogen is still an independent risk factor for the development of PID and associated complications. It is possible that the asymptomatic course of infection caused by M. genitalium can also cause the same reproductive problems as an asymptomatic chlamydia infection. The prevalence of mycoplasma infection in adolescent girls and young women ranges from 2 to 7.3%.

Studies on the management of men with urethritis caused by M. genitalium, has revealed the superiority of azithromycin over doxycycline.