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Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and
Manuel Cina1, Lukas Baumann1, Dianne Egli-Gany1
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
Background:
Mycoplasma genitalium is increasingly seen as an emerging sexually transmitted pathogen, and has been likened to Chlamydia trachomatis, but its natural history is poorly understood. The objectives of this systematic review were to determine M. genitalium incidence, persistence, concordance between sexual partners and the risk of pelvic inflammatory disease (PID).
Methods:
We searched Medline, EMBASE, LILACS, IndMed and African Index Medicus from 1 January 1981 until 17 March 2018. Two independent researchers screened studies for inclusion and extracted data. We examined results in forest plots, assessed heterogeneity and conducted meta-analysis where appropriate. Risk of bias was assessed for all studies.
Results:
We screened 4634 records and included 18 studies; six (4201 women) reported on incidence, five (636 women) on persistence, 10 (1346 women and men) on concordance and three (5139 women) on PID. Incidence in women in two very highly developed countries was 1.07 per 100 person-years (95% CI 0.61 to 1.53, I2 0%). Median persistence of M. genitalium was estimated from one to three months in four studies but 15 months in one study. In 10 studies measuring M. genitalium infection status in couples, 39%-50% of male or female sexual partners of infected participants also had M. genitalium detected. In prospective studies, PID incidence was higher in women with M. genitalium than those without (risk ratio 1.73, 95% CI 0.92 to 3.28, I2 0%, two studies).
Discussion:
Incidence of M. genitalium in very highly developed countries is similar to that for C. trachomatis, but concordance might be lower. Taken together with other evidence about age distribution and antimicrobial resistance in the two infections, M. genitalium is not the new chlamydia. Synthesised data about prevalence, incidence and persistence of M. genitalium infection are inconsistent. These findings can be used for mathematical modelling to investigate the dynamics of M. genitalium.
Registration Numbers:
CRD42015020420, CRD42015020405.
Insights
Mycoplasma genitalium incidence is similar to Chlamydia trachomatis in developed nations, but partner concordance may be lower. Data on M. genitalium prevalence and persistence remain inconsistent, requiring further research.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Mycoplasma genitalium is an emerging sexually transmitted pathogen.
- Its natural history and clinical impact are not well understood.
- Comparison with Chlamydia trachomatis highlights knowledge gaps.
Purpose of the Study:
- To systematically review M. genitalium incidence and persistence.
- To determine sexual partner concordance for M. genitalium.
- To assess the risk of pelvic inflammatory disease (PID) associated with M. genitalium.
Main Methods:
- Systematic literature search of multiple databases (Medline, EMBASE, etc.) from 1981 to 2018.
- Screening of 4634 records, inclusion of 18 studies.
- Meta-analysis and risk of bias assessment for extracted data.
Main Results:
- Incidence in highly developed countries: 1.07 per 100 person-years.
- Median M. genitalium persistence: 1-3 months, with one study reporting 15 months.
- Sexual partner concordance: 39%-50%. PID risk RR 1.73 (95% CI 0.92 to 3.28).
Conclusions:
- M. genitalium incidence is comparable to C. trachomatis, but partner concordance may be lower.
- Inconsistent data on prevalence, incidence, and persistence necessitate further investigation.
- Findings support mathematical modeling of M. genitalium infection dynamics.
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