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Systematic Review and Meta-analysis of the Association Between Mycoplasma genitalium and Pelvic Inflammatory Disease
Kay Htaik1,2, Lenka A Vodstrcil1,2,3, Erica L Plummer1,2
1Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia.
Background:
Differences in opinion concerning the contribution of Mycoplasma genitalium to pelvic inflammatory disease (PID) has resulted in inconsistencies across global testing and treatment guidelines. We conducted a systematic review and meta-analysis to determine the association between M. genitalium and PID and M. genitalium positivity within PID cases to provide a contemporary evidence base to inform clinical practice (PROSPERO registration: CRD42022382156).
Methods:
PubMed, Embase, Medline, and Web of Science were searched to 1 December 2023 for studies that assessed women for PID using established clinical criteria and used nucleic acid amplification tests to detect M. genitalium. We calculated summary estimates of the (1) association of M. genitalium with PID (pooled odds ratio [OR]) and 2) proportion of PID cases with M. genitalium detected (pooled M. genitalium positivity in PID), using random-effects meta-analyses, with 95% confidence intervals (CI).
Results:
Nineteen studies were included: 10 estimated M. genitalium association with PID, and 19 estimated M. genitalium positivity in PID. M. genitalium infection was significantly associated with PID (pooled OR = 1.67 [95% CI: 1.24-2.24]). The pooled positivity of M. genitalium in PID was 10.3% [95% CI: 5.63-15.99]. Subgroup and meta-regression analyses showed that M. genitalium positivity in PID was highest in the Americas, in studies conducted in both inpatient and outpatient clinic settings, and in populations at high risk of sexually transmitted infections.
Conclusions:
M. genitalium was associated with a 67% increase in odds of PID and was detected in about 1 of 10 clinical diagnoses of PID. These data support testing women for M. genitalium at initial PID diagnosis.
Insights
Mycoplasma genitalium infection is linked to a 67% increased risk of pelvic inflammatory disease (PID). Testing for M. genitalium is recommended for women diagnosed with PID to guide treatment.
Area of Science:
- Microbiology
- Infectious Diseases
- Public Health
Background:
- Discrepancies exist regarding Mycoplasma genitalium's role in pelvic inflammatory disease (PID).
- Global testing and treatment guidelines for PID lack consistency due to differing opinions on M. genitalium's contribution.
- A systematic review and meta-analysis were conducted to clarify the association between M. genitalium and PID.
Purpose of the Study:
- To determine the association between M. genitalium and PID.
- To ascertain the prevalence of M. genitalium in diagnosed PID cases.
- To provide evidence for updating clinical practice and guidelines.
Main Methods:
- A systematic literature search was performed across PubMed, Embase, Medline, and Web of Science up to December 1, 2023.
- Studies assessing women for PID using established criteria and detecting M. genitalium via nucleic acid amplification tests were included.
- Random-effects meta-analyses calculated pooled odds ratios for PID association and M. genitalium positivity rates.
Main Results:
- Nineteen studies met the inclusion criteria.
- M. genitalium infection showed a significant association with PID (pooled OR=1.67).
- M. genitalium was detected in 10.3% of PID cases, with higher positivity in the Americas and high-risk populations.
Conclusions:
- M. genitalium is associated with a 67% increased likelihood of PID.
- Approximately 10% of PID diagnoses involve M. genitalium detection.
- Testing for M. genitalium upon initial PID diagnosis is supported by these findings.
