A Silent Epidemic: The Prevalence, Incidence and Persistence of Mycoplasma genitalium Among Young, Asymptomatic High-Risk Women in the United States

Clin Infect Dis. 2018 Jun 18;67(1):73-79. doi: 10.1093/cid/ciy025.


Background: Mycoplasma genitalium can result in pelvic inflammatory disease and adverse pregnancy outcomes. We analyzed data collected from a prospective study of asymptomatic bacterial vaginosis (BV) to determine the natural history of M. genitalium.

Methods: Women aged 15-25 years, with asymptomatic BV and ≥2 risk factors for sexually transmitted infection were recruited from 10 sites throughout the United States. Vaginal swab samples were collected at enrollment and through home-based testing every 2 months over 12 months. M. genitalium nucleic acid amplification testing was performed for M. genitalium using transcription-mediated assays (Hologic). The prevalence, incidence, and persistence of M. genitalium, defined as all positive specimens during follow-up, were estimated with 95% confidence intervals (CIs). Adjusted odds ratios (AOR) were calculated using logistic and Poisson regression to evaluate participant characteristics associated with M. genitalium infection.

Results: Among 1139 women, 233 were M. genitalium positive, for a prevalence of 20.5% (95% CI, 18.2%-22.9%); 42 of 204 had persistent M. genitalium (20.6%). Among 801 M. genitalium-negative women at baseline, the M. genitalium incidence was 36.6 per 100 person-years (95% CI, 32.4-41.3). Black race (AOR, 1.92; 95% CI, 1.09-3.38), age ≤21 years (1.40; 1.03-1.91), and prior pregnancy (1.36; 1.00-1.85) were associated with prevalent M. genitalium; only black race was associated with incident M. genitalium (P = .03).

Conclusions: We identified high rates of prevalent, incident, and persistent M. genitalium infections among young, high-risk women with asymptomatic BV, supporting the need for clinical trials to evaluate the impact of M. genitalium screening on female reproductive health outcomes.

Publication types

  • Multicenter Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Asymptomatic Infections / epidemiology*
  • Coinfection / epidemiology
  • Coinfection / microbiology
  • Female
  • Humans
  • Incidence
  • Mycoplasma Infections / diagnosis
  • Mycoplasma Infections / epidemiology*
  • Mycoplasma genitalium / isolation & purification*
  • Odds Ratio
  • Pelvic Inflammatory Disease / microbiology
  • Prevalence
  • Prospective Studies
  • Regression Analysis
  • Risk Factors
  • Sexual Behavior
  • Sexual Partners
  • Sexually Transmitted Diseases / epidemiology*
  • Sexually Transmitted Diseases / microbiology
  • United States / epidemiology
  • Vagina / microbiology
  • Young Adult