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Clinical Characteristics Associated With Mycoplasma genitalium Infection Among Women at High Risk of HIV and Other STI in Uganda

Vandepitte, Judith MD, MSc*; Bukenya, Justine MD, MPH*; Hughes, Peter MSc*; Muller, Etienne PhD; Buvé, Anne PhD; Hayes, Richard DSc§; Weiss, Helen A. PhD§; Grosskurth, Heiner PhD*,§

Sexually Transmitted Diseases: June 2012 - Volume 39 - Issue 6 - p 487–491
doi: 10.1097/OLQ.0b013e31824b1cf3
Original Study

Background: Mycoplasma genitalium is a common infection of the genitourinary tract, but its pathogenic effects have not been well described, especially in women. The increasing evidence that M. genitalium is associated with HIV infection calls for an urgent consensus on how best to control this infection. The aim of this study was to describe symptoms and signs associated with M. genitalium infection among high-risk women in Uganda.

Methods: A cohort of 1027 female sex workers was recruited in Kampala in 2008. At enrollment, HIV testing was performed, genital specimens were tested for other sexually transmitted infection, and urogenital symptoms and signs were recorded. Endocervical swabs were tested for M. genitalium using a commercial Real-TM PCR assay (Sacace Biotechnologies, Como, Italy). The associations of clinical signs and symptoms with prevalent M. genitalium were investigated using multivariable logistic regression models.

Results: Reported dysuria and presence of mucopurulent vaginal discharge were significantly associated with M. genitalium infection (OR: 1.85, 95% confidence interval: 1.13–3.03 and OR: 1.55, 95% confidence interval: 1.06–2.29, respectively). There was little evidence for an association with cervicitis or with pelvic inflammatory disease.

Conclusions: In this specific population, we found evidence that symptoms of urethritis and mucopurulent vaginal discharge were associated with M. genitalium infection. This supports earlier studies showing that M. genitalium may lead to clinically relevant genitourinary disorders and should be treated. In the absence of sensitive screening tests, further work is needed to validate clinical findings as possible indicators of M. genitalium infection to guide a possible syndromic approach for its control.

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

The authors thank the study participants of the Good Health for Women Project for their collaboration and the study team for their dedication to the work. The authors 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, and Professor Patrick Van der Stuyft, Head of Department of Public Health at the Institute of Tropical Medicine in Antwerp.

Supported by the Medical Research Council (MRC UK) and the European and Developing Countries Clinical Trials Partnership (EDCTP).

Source of Funding: Medical Research Council (MRC UK) and the European and Developing Countries Clinical Trials Partnership (EDCTP).

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 November 10, 2011, and accepted January 13, 2012.

© Copyright 2012 American Sexually Transmitted Diseases Association