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Tuesday, March 11, 2008 - 10:45 AM
A8e

Mycoplasma genitalium infection in women manifests as mild rather than acute cervicitis

Lisa Manhart1, Sara J. Nelson2, Emily B. Hancock1, Jennifer K. H. Wroblewski3, and Patricia A. Totten4. (1) Department of Epidemiology, University of Washington, UW Center for AIDS and STD, 325 9th Ave., Box 359931, Seattle, WA, USA, (2) Department of Epidemiology, Center for AIDS and STD, University of Washington, Harborview Medical Center, Box 359931, 325 9th Ave, Seattle, WA, USA, (3) Department of Medicine, University of Washington, 325 9th Ave., Box 359931, Seattle, WA, (4) Department of Medicine, UW Center for AIDS and STD, Unversity of Washington, Seattle, WA


Background:
Mycoplasma genitalium (MG) is inconsistently associated with cervicitis.

Objective:
To identify clinical features of women infected with MG.

Method:
Between 2000-2006, 1122 women aged 14-53 attending the Public Health-Seattle & King County STD clinic underwent an external genital and speculum exam. Cervical, urine, and self-obtained vaginal specimens were tested for MG by an in-house PCR and a research-use only TMA (Gen-Probe Incorporated, San Diego, CA). Infection with MG was defined by a positive test in any specimen type by either test. Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) were detected by cervical cultures. Mucopurulent cervicitis (MPC) was defined as cervical mucopus and/or >=30 polymorphonuclear leukocytes (PMNs)/HPF in cervical exudates.

Result:
MG was detected in 119 women (10.6%), of whom five (4.2%) were coinfected with GC and 7 (5.9%) with CT. 110 women (9.6%) had MPC. Women with MG were significantly younger (mean age 24.4 vs. 27.2 years, p<0.001) and more often African American (57.3% vs. 34.9%, p<0.001). They were more likely to have cervical discharge (62.2% vs. 52.1%, p=0.04), and this discharge was more often cloudy (21.0% vs. 11.1%, p=0.001) than mucopurulent (3.4% vs. 3.2%, p=0.92). Neither cervical ectopy nor easily induced cervical bleeding were associated with MG and cervical PMNs>=30 were only modestly associated (19.6% vs. 13.1%, p=0.09). Overall, adjusting for hormonal contraceptive use, GC, and CT, MG was strongly associated with cloudy cervical exudates (AOR 2.1; 95% CI 1.29-3.42, p=0.003), but less strongly associated with MPC (AOR 1.7; 0.98-3.05, p=0.06). Interestingly, among women>=25 years the relationship between MG and MPC was stronger (AOR 2.8; 1.18-6.50, p=0.019).

Conclusion:
MG infection was more consistently associated with cloudy than mucopurulent cervical exudates and moderately associated with MPC. Older women may have different clinical manifestations.

Implications:
Future research on MG infection should evaluate the local inflammatory response and effects of age.

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