MONTREAL — Mycoplasma genitalium is probably an underrecognized cause of some cases of cervicitis, but the role of the physician in screening for and treating this organism remains unclear, according to Dr. Harold Wiesenfeld of Magee-Womens Hospital and the University of Pittsburgh.
Dr. Wiesenfeld outlined his work showing a link between M. genitalium and subclinical pelvic inflammatory disease, as well as more recent findings that implicate the organism in cervicitis, at the annual meeting of the Infectious Diseases Society for Obstetrics and Gynecology.
“Many cases, perhaps most cases, of cervicitis occur in women who are negative for the traditional pathogens known to cause cervicitis, such as Neisseria gonorrhoeae and Chlamydia trachomatis,” he said in an interview. “Our findings may explain the etiology of cervicitis in some women.”
His study of 524 women at risk for lower genital tract infection and undergoing testing for sexually transmitted disease found elevated polymorphonuclear leukocytes (PMNs), a microscopic marker for cervical inflammation, in 22% of the women.
M. genitalium was identified in 8% of the overall cohort, but occurred more frequently among those with elevated PMNs compared with those without (37% vs. 21%). In fact, among all women with elevated PMNs, M. genitalium was the most common pathogen “eclipsing the more traditionally recognized cervicitis organisms,” he said.
In contrast, only 32% of those with elevated PMNs had C. trachomatis, 22% had N. gonorrhoeae, 22% had bacterial vaginosis, and 21% had Trichomonas vaginalis.
After logistic regression, infection with M. genitalium was independently associated with elevated PMNs, with an odds ratio of 2.5, he said.
“As there is an independent association between M. genitalium and cervical inflammation, it is likely that M. genitalium is the cause of a true cervical infection rather than just a colonizing organism,” he said. “I would not expect a colonizing organism to cause a cervical inflammatory response.”
To rule out confounding STDs, the analysis was then restricted to 345 women who had tested negative for gonorrhea, chlamydia, and Trichomonas species. Eight percent of this cohort tested positive for M. genitalium, and 46% of this group had elevated PMNs compared with the 18 women who had no STD infections.
“After controlling for age, M. genitalium infection was independently associated with elevated PMNs with an odds ratio of 4.7,” he said.
Only a minority of women had clinical signs of cervicitis, and there were no clinical differences between those who tested positive or negative for M. genitalium, Dr. Wiesenfeld said.
The findings shed new light on the contributions of M. genitalium to cervicitis, but “at this point I do not think that these findings will change the routine management of cervicitis,” he said.