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Natural history of Mycoplasma genitalium Infection in a Cohort of Female Sex Workers in Kampala, Uganda

Vandepitte, Judith MD*; Weiss, Helen A. PhD; Kyakuwa, Nassim BSc*; Nakubulwa, Susan BSc*; Muller, Etienne PhD; Buvé, Anne PhD§; Van der Stuyft, Patrick PhD§∥; Hayes, Richard DSc; Grosskurth, Heiner PhD*†

Sexually Transmitted Diseases: May 2013 - Volume 40 - Issue 5 - p 422–427
doi: 10.1097/OLQ.0b013e31828bfccf
Original Study

Background: There have been few studies of the natural history of Mycoplasma genitalium in women. We investigated patterns of clearance and recurrence of untreated M. genitalium infection in a cohort of female sex workers in Uganda.

Methods: Women diagnosed as having M. genitalium infection at enrollment were retested for the infection at 3-month intervals. Clearance of infection was defined as testing negative after having a previous positive result: persistence was defined as testing positive after a preceding positive test result, and recurrence as testing positive after a preceding negative test result. Adjusted hazard ratios for M. genitalium clearance were estimated using Cox proportional hazards regression.

Results: Among 119 participants infected with M. genitalium at enrollment (prevalence, 14%), 55% had spontaneously cleared the infection within 3 months; 83%, within 6; and 93%, within 12 months. The overall clearance rate was 25.7/100 person-years (pyr; 95% confidence interval, 21.4–31.0). HIV-positive women cleared M. genitalium infection more slowly than did HIV-negative women (20.6/100 pyr vs. 31.3/100 pyr, P = 0.03). The clearance rate was slower among HIV-positive women with CD4 counts less than 350/mL3 than among those with higher CD4 counts (9.88/100 pyr vs. 29.5/100 pyr, P <; 0.001). After clearing the infection, M. genitalium infection recurred in 39% women.

Conclusions: M. genitalium is likely to persist and recur in the female genital tract. Because of the urogenital tract morbidity caused by the infection and the observed association with HIV acquisition, further research is needed to define screening modalities, especially in populations at high risk for HIV, and to optimize effective and affordable treatment options.

A study among high-risk women in Kampala found that untreated Mycoplasma genitalium infection is likely to persist, especially in most immune-compromised women, and to recur over time.

From the *MRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda; †MRC Tropical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, United Kingdom; ‡STI Reference Centre, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa; §Prince Leopold Institute of Tropical Medicine, Antwerp, Belgium; and ∥University of Ghent, Ghent, Belgium

The authors thank the study participants for their collaboration and the study team for their dedication to the work. They also thank Professor David Lewis, Head of Department, Centre for HIV and Sexually Transmitted Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa.

Supported by Medical Research Council, UK, and European and Developing Countries Clinical Trials Partnership.

Conflicts of interest: None declared.

Correspondence: Judith Vandepitte, MD, MRC/UVRI Uganda Research Unit on AIDS, PO Box 49, Entebbe, Uganda. E-mail: Judith.vandepitte@mrcuganda.org.

Received for publication September 25, 2012, and accepted November 28, 2012.

© Copyright 2013 American Sexually Transmitted Diseases Association