Failure of cefoxitin and doxycycline to eradicate endometrial Mycoplasma genitalium and the consequence for clinical cure of pelvic inflammatory disease

University of Pittsburgh, Department of Epidemiology, 130 DeSoto Street, 516B Parran Hall, Pittsburgh, PA 15261, USA.
Sexually transmitted infections (Impact Factor: 3.4). 05/2008; 84(5):338-42. DOI: 10.1136/sti.2008.030486
Source: PubMed


As Mycoplasma genitalium is associated with pelvic inflammatory disease (PID), we examined the efficacy of a commonly used PID antimicrobial in treating M genitalium upper genital tract infection.
In the PID Evaluation and Clinical Health study of inpatient versus outpatient treatment, 682 women treated with cefoxitin and doxycycline for clinically suspected PID had stored cervical and endometrial specimens available for analysis. In the current sub study, we compared baseline endometritis, short term treatment failure (continued endometritis and pelvic pain 30 days following treatment) and sequelae among women with and without M genitalium, identified using PCR.
Endometrial M genitalium was associated with baseline endometritis (adjusted OR 3.0, 95% CI 1.5 to 6.1). Among women with a positive baseline M genitalium test, 41% tested positive again 30 days following treatment. Women testing positive compared to those testing negative for M genitalium at baseline had an increased risk of short-term treatment failure (RR 4.6, 95% CI 1.1 to 20.1). Rates of sequelae, including infertility (22%), recurrent PID (31%) and chronic pelvic pain (42%), were high among women testing positive for endometrial M genitalium at baseline. There was a non-significant trend towards increased infertility, chronic pelvic pain and recurrent PID, and decreased pregnancy and live birth following M genitalium infection.
M genitalium is associated with endometritis and short-term PID treatment failure. Cefoxitin and doxycycline, a Centers for Disease Control and Prevention recommended PID treatment regimen, is ineffective for the treatment of M genitalium upper genital tract infection.

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Available from: Catherine L Haggerty, Oct 01, 2015
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    • "MG was found to be positively associated with urethritis and microscopic signs of cervicitis and/or mucopurulent cervical discharge in a literature review [11]. In addition, MG was found to be positively associated with PID [4,5][12,13]. The associations of MG with preterm birth and of MG with tubal infertility were also reported [6,7]. "
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    ABSTRACT: Background Mycoplasma genitalium (MG) is one of the common causes of non-gonococcal urethritis (NGU) in men and is associated with cervicitis, endometritis, and pelvic inflammatory diseases (PID) in women. The prevalence of MG infection has been reported to be high among female sex workers (FSWs) in many countries, but limited information is known among this population in China. Methods From July to September 2009, venue-based FSWs were recruited in two cities (Wuzhou and Hezhou) of Guangxi Autonomous Region in southwest China. Information of socio-demographic and behavioral characteristics was collected by a questionnaire-based interview. Cervical specimens were obtained for detection of MG using a real-time polymerase chain reaction (PCR) assay targeting mgpA gene. Results The overall prevalence of MG infection among 810 FSWs was 13.2% (95% CI = 10.87%–15.52%). MG infection was significantly associated with less education (adjusted odds ratio (AOR) = 2.36, 95% CI = 1.15–4.87) consisting of junior high school or below, being single (AOR = 2.27, 95% CI = 1.42–3.62), migrant background (AOR = 2.03, 95% CI = 1.29–3.20), and absence of any STI symptoms in the previous year (AOR = 1.66, 95% CI = 1.09–2.52). Conclusions MG infection was prevalent among FSWs in the study areas. This pattern of infection suggests that an increasing attention should be paid to MG screening and treatment in this high risk population.
    BMC Public Health 06/2012; 12(1):414. DOI:10.1186/1471-2458-12-414 · 2.26 Impact Factor
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    • "Although bacterial vaginosis-associated and mycoplasmal organisms have been associated with PID [4–6, 13, 25, 27–32], independent of gonococcal and chlamydial infection [4] [28], less is known about the etiology, treatment, and sequelae of nongonococcal, nonchlamydial PID. This paper reviews recent evidence for the role of M. genitalium in PID and subsequent reproductive and gynecologic outcomes. "
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    ABSTRACT: Mycoplasma genitalium is a sexually transmitted pathogen that is increasingly identified among women with pelvic inflammatory disease (PID). Although Chlamydia trachomatis and Neisseria gonorrhoeae frequently cause PID, up to 70% of cases have an unidentified etiology. This paper summarizes evidence linking M. genitalium to PID and its long-term reproductive sequelae. Several PCR studies have demonstrated that M. genitalium is associated with PID, independent of gonococcal and chlamydial infection. Most have been cross-sectional, although one prospective investigation suggested that M. genitalium was associated with over a thirteenfold risk of endometritis. Further, a nested case-control posttermination study demonstrated a sixfold increased risk of PID among M. genitalium positive patients. Whether or not M. genitalium upper genital tract infection results in long-term reproductive morbidity is unclear, although tubal factor infertility patients have been found to have elevated M. genitalium antibodies. Several lines of evidence suggest that M. genitalium is likely resistant to many frequently used PID treatment regimens. Correspondingly, M. genitalium has been associated with treatment failure following cefoxitin and doxycycline treatment for clinically suspected PID. Collectively, strong evidence suggests that M. genitalium is associated with PID. Further study of M. genitalium upper genital tract infection diagnosis, treatment and long-term sequelae is warranted.
    Infectious Diseases in Obstetrics and Gynecology 12/2011; 2011(5):959816. DOI:10.1155/2011/959816
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    • "These rates of M. genitalium are similar to those seen for C. trachomatis and N. gonorrhoeae in the PEACH study of urban women in the United States. A recent analysis from the PEACH study noted that rates of short-term failure (persistent endometritis and pelvic pain), infertility, recurrent PID, and chronic pelvic pain were high among women with endometrial M. genitalium at baseline [40]. Subsequently, it has been demonstrated that women with M. genitalium infection (similar to those with chlamydial infection) present with fewer clinical signs and symptoms of acute PID than those with gonococcal infection [41]. "
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    ABSTRACT: Pelvic inflammatory disease (PID), one of the most common infections in nonpregnant women of reproductive age, remains an important public health problem. It is associated with major long-term sequelae, including tubal factor infertility, ectopic pregnancy, and chronic pelvic pain. In addition, treatment of acute PID and its complications incurs substantial health care costs. Prevention of these long-term sequelae is dependent upon development of treatment strategies based on knowledge of the microbiologic etiology of acute PID. It is well accepted that acute PID is a polymicrobic infection. The sexually transmitted organisms, Neisseria gonorrhoeae and Chlamydia trachomatis, are present in many cases, and microorganisms comprising the endogenous vaginal and cervical flora are frequently associated with PID. This includes anaerobic and facultative bacteria, similar to those associated with bacterial vaginosis. Genital tract mycoplasmas, most importantly Mycoplasma genitalium, have recently also been implicated as a cause of acute PID. As a consequence, treatment regimens for acute PID should provide broad spectrum coverage that is effective against these microorganisms.
    Infectious Diseases in Obstetrics and Gynecology 12/2011; 2011(1064-7449):561909. DOI:10.1155/2011/561909
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