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

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.