Mycoplasma genitalium Incidence, Organism Load, and Treatment Failure in a Cohort of Young Australian Women

Centre for Excellence in Rural Sexual Health, Rural Health Academic Centre, Melbourne Medical School, University of Melbourne, Victoria 3010, Australia.
Clinical Infectious Diseases (Impact Factor: 9.42). 01/2013; 56(8). DOI: 10.1093/cid/cis1210
Source: PubMed

ABSTRACT Background. Mycoplasma genitalium (MG) is an emerging sexually transmitted infection (STI) that is potentially associated with serious reproductive tract sequelae in women. This study aimed to estimate rates of MG incidence and treatment failure and provide estimates of organism load for MG infections.Methods. 1110 women aged 16 to 25 years were recruited from primary care clinics in Australia. Women were tested for MG at baseline, 6 months and 12 months and MG organism load was measured by quantitative PCR. All MG positive cases were also screened for MG 23S rRNA gene point mutations shown to confer azithromycin resistance using high resolution melt following PCR.Results. MG incidence rate was 1.3 per 100 person years (95% CI: 0.8, 2.3) (n=14) and women reporting three or more sex partners in the last 12 months had an increased rate of incident infection [RR=5.1 (95%CI: 1.3, 19.6)]. There were 3 cases of MG re-infection with a re-infection rate of 0.8 per 100 person years (95% CI: 0.1, 0.9). Organism load was higher for prevalent than incident infection (p=0.04). There were 3 cases of treatment failure cases [9.4% (95%CI: 2.0, 25.0)] and organism load was higher in the cases with treatment failure than the successfully treated cases (p<0.01). An MG 23S rRNA mutation was detected in 5 cases; 3 cases of treatment failure and 2 successfully treated cases.Conclusions. While MG incidence was relatively low, testing should be recommended for women considered to be at increased risk of infection based on sexual history. Our results also suggest that organism load might be important in influencing azithromycin treatment failure.

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May 21, 2014