Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis.

To determine the association between Mycoplasma genitalium infection and female reproductive tract syndromes through meta-analysis, English-language, peer-reviewed studies were identified via PubMed, Embase, Biosis, Cochrane Library, and reference review. Two reviewers independently extracted data. Random-effects models were employed to calculate summary estimates, between-study heterogeneity was evaluated using I(2) statistics, publication bias was assessed via funnel plots and the Begg and Egger tests, and methodologic quality was rated. Mycoplasma genitalium infection was significantly associated with increased risk of cervicitis (pooled odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.35-2.04]), pelvic inflammatory disease (pooled OR, 2.14 [95% CI, 1.31-3.49]), preterm birth (pooled OR, 1.89 [95% CI, 1.25-2.85]), and spontaneous abortion (pooled OR, 1.82 [95% CI, 1.10-3.03]). Risk of infertility was similarly elevated (pooled OR, 2.43 [95% CI, .93-6.34]). In subanalyses accounting for coinfections, all associations were stronger and statistically significant. Testing of high-risk symptomatic women for M. genitalium may be warranted.

[1]  K. Workowski,et al.  Sexually transmitted diseases treatment guidelines, 2015. , 2015, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[2]  J. Kaldor,et al.  Trichomonas vaginalis as a Cause of Perinatal Morbidity: A Systematic Review and Meta-Analysis , 2014, Sexually transmitted diseases.

[3]  M. Hacker,et al.  Mycoplasma genitalium and preterm delivery at an urban community health center , 2013, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics.

[4]  S. Azariah,et al.  Cervicitis: limited clinical utility for the detection of Mycoplasma genitalium in a cross-sectional study of women attending a New Zealand sexual health clinic. , 2013, Sexual health.

[5]  L. Meyn,et al.  O04.6  Mycoplasma Genitalium- Is It a Pathogen in Acute Pelvic Inflammatory Disease (PID)? , 2013, Sexually Transmitted Infections.

[6]  J. Schillinger,et al.  O04.5 Comparison of the Clinical and Demographic Characteristics of Neonatal Herpes Infections Caused by Herpes Simplex Virus Type 1 and Type 2; Findings from a Population-Based Surveillance System, 2006–2012 , 2013, Sexually Transmitted Infections.

[7]  P. Adamski,et al.  Bacterial infections of the lower genital tract in fertile and infertile women from the southeastern Poland. , 2013, Ginekologia polska.

[8]  N. Verlander,et al.  Prevalence, clinical features and quantification of genital non-viral infections , 2013, International journal of STD & AIDS.

[9]  Navneet R. Hakhu,et al.  Standard treatment regimens for nongonococcal urethritis have similar but declining cure rates: a randomized controlled trial. , 2013, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  M. Hobbs,et al.  Mycoplasma genitalium infection in women attending a sexually transmitted infection clinic: diagnostic specimen type, coinfections, and predictors. , 2012, Sexually transmitted diseases.

[11]  R. Hayes,et al.  Clinical Characteristics Associated With Mycoplasma genitalium Infection Among Women at High Risk of HIV and Other STI in Uganda , 2012, Sexually transmitted diseases.

[12]  S. Osser,et al.  Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. , 2012, American journal of obstetrics and gynecology.

[13]  H. Cárdenas,et al.  Mycoplasmateceae species are not found in Fallopian tubes of women with tubo-peritoneal infertility. , 2012, The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases.

[14]  S. Choi,et al.  The Prevalence of Vaginal Microorganisms in Pregnant Women with Preterm Labor and Preterm Birth , 2012, Annals of laboratory medicine.

[15]  R. Hayes,et al.  Prevalence and correlates of Mycoplasma genitalium infection among female sex workers in Kampala, Uganda. , 2012, The Journal of infectious diseases.

[16]  D. Taylor-Robinson,et al.  Difficulties experienced in defining the microbial cause of pelvic inflammatory disease , 2012, International journal of STD & AIDS.

[17]  J. Sterne,et al.  The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials , 2011, BMJ : British Medical Journal.

[18]  A. Bahador,et al.  Prevalence of Chlamydia trachomatis and Mycoplasma genitalium in pregnant women of Sabzevar-Iran , 2011, Iranian journal of microbiology.

[19]  D. Taylor-Robinson,et al.  Mycoplasma genitalium: from Chrysalis to Multicolored Butterfly , 2011, Clinical Microbiology Reviews.

[20]  C. Mcgowin,et al.  Mycoplasma genitalium: An Emerging Cause of Sexually Transmitted Disease in Women , 2011, PLoS pathogens.

[21]  R. Ness,et al.  Microbial Correlates of Delayed Care for Pelvic Inflammatory Disease , 2011, Sexually transmitted diseases.

[22]  L. Lopez,et al.  Re-evaluating the treatment of nongonococcal urethritis: emphasizing emerging pathogens--a randomized clinical trial. , 2011, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[23]  Stuart Berman,et al.  Sexually transmitted diseases treatment guidelines, 2010. , 2010, MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports.

[24]  S. Kerry,et al.  Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. , 2010, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[25]  R. Cumming,et al.  Mycoplasma genitalium is associated with cervicitis and HIV infection in an urban Australian STI clinic population , 2010, Sexually Transmitted Infections.

[26]  M. Trent,et al.  Estimating the Direct Costs of Pelvic Inflammatory Disease in Adolescents: A Within-System Analysis , 2010, Sexually transmitted diseases.

[27]  L. Falk.  The overall agreement of proposed definitions of mucopurulent cervicitis in women at high risk of Chlamydia infection. , 2010, Acta dermato-venereologica.

[28]  R. Ness,et al.  Mycoplasma genitalium among Young, Urban Pregnant Women , 2010, Infectious diseases in obstetrics and gynecology.

[29]  R. Romero,et al.  The clinical significance of eosinophils in the amniotic fluid in preterm labor , 2010, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[30]  J. Baseman,et al.  Mycoplasma genitalium symptoms, concordance and treatment in high-risk sexual dyads , 2010, International journal of STD & AIDS.

[31]  K. Holmes,et al.  Correlates of Cervical Mycoplasma genitalium and Risk of Preterm Birth Among Peruvian Women , 2010, Sexually transmitted diseases.

[32]  K. Persson,et al.  The association between Mycoplasma genitalium and pelvic inflammatory disease after termination of pregnancy , 2010, BJOG : an international journal of obstetrics and gynaecology.

[33]  T. Quinn,et al.  Mycoplasma genitalium as a Contributor to the Multiple Etiologies of Cervicitis in Women Attending Sexually Transmitted Disease Clinics , 2009, Sexually transmitted diseases.

[34]  T. Mroczkowski,et al.  A randomized comparison of azithromycin and doxycycline for the treatment of Mycoplasma genitalium-positive urethritis in men. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[35]  U. Kasprzykowska,et al.  Occurrence of Mycoplasma genitalium in fertile and infertile women. , 2009, Fertility and sterility.

[36]  N. Reinton,et al.  Mycoplasma genitalium in women with lower genital tract inflammation , 2008, Sexually Transmitted Infections.

[37]  S. Birkelund,et al.  Mycoplasma genitalium, Chlamydia trachomatis, and tubal factor infertility--a prospective study. , 2008, Fertility and sterility.

[38]  R. NailetArráiz,et al.  [Mycoplasma genitalium detection and correlation with clinical manifestations in population of the Zulia State, Venezuela]. , 2008 .

[39]  S. Kelsey,et al.  Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease , 2008, Sexually Transmitted Infections.

[40]  M. Hobbs,et al.  Mycoplasma genitalium Detected by Transcription-Mediated Amplification Is Associated With Chlamydia trachomatis in Adolescent Women , 2008, Sexually transmitted diseases.

[41]  J. Baeten,et al.  High Mycoplasma genitalium organism burden is associated with shedding of HIV-1 DNA from the cervix. , 2008, The Journal of infectious diseases.

[42]  E. Kihlström,et al.  Leucocyte esterase testing of first-voided urine and urethral and cervical smears to identify Mycoplasma genitalium-infected men and women , 2007, International journal of STD & AIDS.

[43]  J. Higgins,et al.  Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: a systematic review and annotated bibliography. , 2007, International journal of epidemiology.

[44]  J. Jensen,et al.  A serological study of the role of Mycoplasma genitalium in pelvic inflammatory disease and ectopic pregnancy , 2007, Sexually Transmitted Infections.

[45]  N. Khonde,et al.  The syndromic management of vaginal discharge using single-dose treatments: a randomized controlled trial in West Africa. , 2006, Bulletin of the World Health Organization.

[46]  M. Hudspeth,et al.  Comparison of Transcription-Mediated Amplification and PCR Assay Results for Various Genital Specimen Types for Detection of Mycoplasma genitalium , 2006, Journal of Clinical Microbiology.

[47]  C. Gaydos,et al.  Comparison between the Gen-Probe Transcription-Mediated Amplification Trichomonas vaginalis Research Assay and Real-Time PCR for Trichomonas vaginalis Detection Using a Roche LightCycler Instrument with Female Self-Obtained Vaginal Swab Samples and Male Urine Samples , 2006, Journal of Clinical Microbiology.

[48]  R. Ness,et al.  Mycoplasma Genitalium Among Women With Nongonococcal, Nonchlamydial Pelvic Inflammatory Disease , 2006, Infectious diseases in obstetrics and gynecology.

[49]  J. Piper,et al.  Cervicitis and Genitourinary Symptoms in Women Culture Positive for Mycoplasma genitalium , 2006, American journal of reproductive immunology.

[50]  Allan Donner,et al.  The prevalence of stillbirths: a systematic review , 2006, Reproductive health.

[51]  N. Sakuragi,et al.  Association between Preterm Birth and Vaginal Colonization by Mycoplasmas in Early Pregnancy , 2006, Journal of Clinical Microbiology.

[52]  D. Theriaque,et al.  Assessing the relationship between preterm delivery and various microorganisms recovered from the lower genital tract , 2006, The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians.

[53]  C. Cohen,et al.  Detection of Mycoplasma genitalium in women with laparoscopically diagnosed acute salpingitis , 2005, Sexually Transmitted Infections.

[54]  J. Jensen,et al.  Mycoplasma genitalium: prevalence, clinical significance, and transmission , 2005, Sexually Transmitted Infections.

[55]  J. Jensen,et al.  Signs and symptoms of urethritis and cervicitis among women with or without Mycoplasma genitalium or Chlamydia trachomatis infection , 2005, Sexually Transmitted Infections.

[56]  M. Alary,et al.  Mycoplasma genitalium: an organism commonly associated with cervicitis among west African sex workers , 2005, Sexually Transmitted Infections.

[57]  S. Kerry,et al.  Prevalence of Mycoplasma genitalium in early pregnancy and relationship between its presence and pregnancy outcome , 2004, BJOG : an international journal of obstetrics and gynaecology.

[58]  Michael J. Schlicht,et al.  High Prevalence of Genital Mycoplasmas among Sexually Active Young Adults with Urethritis or Cervicitis Symptoms in La Crosse, Wisconsin , 2004, Journal of Clinical Microbiology.

[59]  Margaret-Mary G. Wilson,et al.  Sexually transmitted diseases. , 2003, Clinics in geriatric medicine.

[60]  P. Rogers,et al.  Associations between Mycoplasma genitalium, Chlamydia trachomatis, and pelvic inflammatory disease , 2003, Sexually transmitted infections.

[61]  K. Holmes,et al.  Mucopurulent cervicitis and Mycoplasma genitalium. , 2003, The Journal of infectious diseases.

[62]  E. Frost,et al.  Mycoplasma genitalium is not associated with adverse outcomes of pregnancy in Guinea-Bissau , 2002, Sexually Transmitted Infections.

[63]  S. Thompson,et al.  Quantifying heterogeneity in a meta‐analysis , 2002, Statistics in medicine.

[64]  I. Casin,et al.  High Prevalence of Mycoplasma genitalium in the Lower Genitourinary Tract of Women Attending a Sexually Transmitted Disease Clinic in Paris, France , 2002, Sexually transmitted diseases.

[65]  K. Holmes,et al.  Association between Mycoplasma genitalium and acute endometritis , 2002, The Lancet.

[66]  S. Birkelund,et al.  Serological investigation of Mycoplasma genitalium in infertile women. , 2001, Human reproduction.

[67]  J. Schwebke,et al.  Midtrimester vaginal Mycoplasma genitalium in women with subsequent spontaneous preterm birth. , 2001, American journal of obstetrics and gynecology.

[68]  Mark W. Lipsey,et al.  Practical Meta-Analysis , 2000 .

[69]  G. Smith,et al.  Bias in meta-analysis detected by a simple, graphical test , 1997, BMJ.

[70]  T. Deguchi,et al.  Mycoplasma genitalium in the Cervices of Japanese Women , 1997, Sexually transmitted diseases.

[71]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[72]  D. Taylor-Robinson,et al.  Detection of Mycoplasma Genitalium in the Genitourinary Tract of Women by the Polymerase Chain Reaction , 1991, International journal of STD & AIDS.

[73]  R. Brunham,et al.  Pelvic inflammatory disease. , 2006, The New England journal of medicine.

[74]  D. Taylor-Robinson,et al.  SEROLOGICAL EVIDENCE IMPLICATING MYCOPLASMA GENITALIUM IN PELVIC INFLAMMATORY DISEASE , 1984, The Lancet.

[75]  J. Higgins.  Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration , 2011 .

[76]  C. Bias.  The Cochrane Collaboration's tool for assessing risk of bias in randomised trials , 2011 .

[77]  S. Kelsey,et al.  Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease. , 2009, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[78]  Nailet Arráiz R,et al.  [Mycoplasma genitalium detection and correlation with clinical manifestations in population of the Zulia State, Venezuela]. , 2008, Revista chilena de infectologia : organo oficial de la Sociedad Chilena de Infectologia.

[79]  J. Ross.  Pelvic inflammatory disease. , 2005, Clinical evidence.

[80]  Bias in meta›analysis detected by a simple, graphical test , 1998 .

[81]  G. Kristensen,et al.  Significance of antibodies to Mycoplasma genitalium in salpingitis. , 1987, European journal of clinical microbiology.

[82]  P. Furr,et al.  Serological evidence that chlamydiae and mycoplasmas are involved in infertility of women. , 1985, Journal of reproduction and fertility.