Clinical presentation of Mycoplasma genitalium Infection versus Neisseria gonorrhoeae infection among women with pelvic inflammatory disease.

The clinical presentation of Mycoplasma genitalium in women with pelvic inflammatory disease (PID) is not very well described, but clinicians will find this study by Short et al. helpful in this regard. The study gives us a toolbox to help identify M. genitalium-infected women and increase awareness of testing for this pathogen, so we may treat it and avoid reproductive morbidity in these patients.

They have used a large cohort of women with PID for this purpose, and 722 women enrolled in the PEACH study were initially screened for Chlamydia trachomatis and Neisseria gonorrheae and had baseline clinical parameters recorded. Stored samples were analysed for the presence of M. genitalium by PCR and found in 47 women with PID, 22 as monoinfection, 16 as M. genitalium and N. gonorrhoeae coinfection and 9 as M.genitalium and C. trachomatis coinfection. The main finding was that PID patients with M. genitalium were less likely to have fever and elevated systemic inflammatory markers than patiens with N. gonorrheae. Mucopurolent cervicitis was also less frequent and pain scores were lower, hence the clinical characteristics for M. genitalium-infected patients resembled the women with C. trachomatis infection, who were generally less symptomatic. The study only enrolled symptomatic patients; hence the degree to which M. genitalium infection presents itself as asymptomatic cannot be evaluated from this study. The association of M. genitalium infection with symptoms has been somewhat debated, because asymptomatic M. genitalium infection seems frequent and the presence of signs and symptoms among M. genitalium-infected patients have not been shown to be more frequent than among those testing negative for M. genitalium. But this study of symptomatic PID patients provides us with a good description of signs and symptoms found among M. genitalium-infected women, and although no distinct clinical feature was noted, it is helpful to know that, among symptomactic M. genitalium-infected women, 64% experience abnormal vaginal discharge, 59% have bacterial vaginosis, 41% report non-menstrual vaginal bleeding, 77% report bilateral adnexal tenderness but 0% have fever and 4% have raised C-reactive protein.

Acknowledgements: I would like to thank Christian Wejse for their assistance in the preparation of this evaluation.