Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum Associated With Specific Genital Symptoms and Clinical Signs in Nonpregnant Women?

Erica L Plummer; Lenka A Vodstrcil; Kaveesha Bodiyabadu; Gerald L Murray; Michelle Doyle; Rosie L Latimer; Christopher K Fairley; Matthew Payne; Eric P F Chow; Suzanne M Garland; Catriona S Bradshaw

doi:10.1093/cid/ciab061

Are Mycoplasma hominis, Ureaplasma urealyticum and Ureaplasma parvum Associated With Specific Genital Symptoms and Clinical Signs in Nonpregnant Women?

Clin Infect Dis. 2021 Aug 16;73(4):659-668. doi: 10.1093/cid/ciab061.

Authors

Erica L Plummer^{1

2}, Lenka A Vodstrcil^{1

2}, Kaveesha Bodiyabadu^{3

4

5}, Gerald L Murray^{3

4

6}, Michelle Doyle², Rosie L Latimer^{1

2}, Christopher K Fairley^{1

2}, Matthew Payne⁷, Eric P F Chow^{1

2

8}, Suzanne M Garland^{3

4

6}, Catriona S Bradshaw^{1

2

8}

Affiliations

¹ Central Clinical School, Monash University, Melbourne, Australia.
² Melbourne Sexual Health Centre, Alfred Health, Melbourne, Australia.
³ Murdoch Children's Research Institute, Parkville, Australia.
⁴ Women's Centre for Infectious Diseases, The Royal Women's Hospital, Parkville, Australia.
⁵ SpeeDx Pty Ltd, Sydney, Australia.
⁶ Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Australia.
⁷ Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, Australia.
⁸ Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia.

PMID: 33502501
DOI: 10.1093/cid/ciab061

Abstract

Background: There is limited evidence supporting an association between Mycoplasma hominis, Ureaplasma urealyticum, and Ureaplasma parvum with symptoms or disease in nonpregnant women. However, testing and reporting of these organisms frequently occurs, in part due to their inclusion in multiplex-PCR assays for sexually transmitted infection (STI) detection. We investigated if M. hominis, U. urealyticum, and U. parvum were associated with symptoms and/or signs in nonpregnant women attending a sexual health service.

Methods: Eligible women attending the Melbourne Sexual Health Centre completed a questionnaire regarding sexual practices and symptoms. Symptomatic women underwent examination. Women were assessed for bacterial vaginosis (BV) and vulvovaginal candidiasis (VVC), and tested for M. hominis, U. urealyticum, and U. parvum, and 4 nonviral STIs using a commercial multiplex-PCR.

Results: 1272 women were analyzed. After adjusting for STIs and VVC, M. hominis was associated with abnormal vaginal discharge (aOR = 2.70, 95%CI:1.92-3.79), vaginal malodor (aOR = 4.27, 95%CI:3.08-5.91), vaginal pH > 4.5 (aOR = 4.27, 95%CI:3.22-5.66), and presence of clue cells (aOR = 8.08, 95%CI:5.68-11.48). Ureaplasma spp. were not associated with symptoms/signs. Bacterial vaginosis was strongly associated with M. hominis (aOR = 8.01, 95%CI:5.99-10.71), but was not associated with either Ureaplasma spp. In stratified analyses, M. hominis was associated with self-reported vaginal malodor and clinician-recorded vaginal discharge in women with BV, but not with symptoms/signs in women without BV.

Conclusions: Only M. hominis was associated with symptoms/signs, and these were manifestations of BV. Importantly, M. hominis was not associated with symptoms/signs in women without BV. These findings do not support routine testing for M. hominis, U. urealyticum, and U. parvum in nonpregnant women.

Keywords: Mycoplasma hominis; Ureaplasma parvum; Ureaplasma urealyticum; bacterial vaginosis; nonpregnant women; symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Mycoplasma Infections* / diagnosis
Mycoplasma Infections* / epidemiology
Mycoplasma hominis
Ureaplasma
Ureaplasma Infections* / diagnosis
Ureaplasma Infections* / epidemiology
Ureaplasma urealyticum
Vagina

Grants and funding

APP1144040/NHMRC