Evidence of Low Rates of Mycoplasma Genitalium Assessment Among Commercially Insured Women with an STI-Related Diagnosis

Background: Mycoplasma genitalium is a sexually transmitted infection (STI) suspected to be present in 15-20% of symptomatic adolescent women with sequelae similar to Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG). This analysis describes the prevalence of M. genitaliumassessment among women with a diagnosis consistent with STI-related sequelae.

Methods: Using administrative claims data from the Truven Health MarketScan Commercial Claims and Encounters Database, we identified women ages 18-55 who received both a Pap test and a diagnosis consistent with STI-related sequelae (such as vaginitis, cervicitis, endometritis, pelvic inflammatory disease) between January 2012 and October 2015. The primary outcome was testing for presence of M. genitaliumcompared to the use of CT/NG tests within 30 days of a diagnosis consistent with STI-related sequelae.

Results: A total of 5,945,930 women ages 18-24 and 25,141,414 ages 25-55 met the inclusion criteria, of which 1,388,581 (23.4%) and 8,426,473 (33.5%) received a Pap test, respectively. Approximately one-third (37.8%) of women ages 18-24 and one-fourth (24.7%) of women ages 25-55 with a Pap test had a diagnosis consistent with STI-related sequelae. Among women with one of these diagnoses, 53.1% of women ages 18-24 and 24.7% of women ages 25-55 had a CT/NG test within 30 days of the diagnosis, while less than 8% had an M. genitalium screening, regardless of age. M. genitalium test rates were also similar by type of potential STI-related sequelae in both age cohorts (ranges 8.2-10.5% and 4.5-8.4%). Only 2.2% of women who received a CT/NG test, but no M. genitaliumtest, had a subsequent diagnosis of CT/NG.

Conclusions: Assessment rates for M. genitalium were low (<8%) among women with potential STI-related diagnoses compared to CT/NG rates which were much higher. These results demonstrate the missed opportunity to identify other common pathogens and improve STI detection and reduce STI related morbidity and sequelae.