Mycoplasma genitalium Prevalence and Variability Based on Gender, Race and Sexual Preference in Patients Attending the Oakland County Health Department Disease Clinic

Background: Mycoplasma genitalium is an important emerging pathogen implicated in male urethritis as well as cervicitis and pelvic inflammatory disease in women. The epidemiology of M. genitalium resembles that of C. trachomatis and N. gonorrhea as all are found more frequently in younger, sexually active individuals and African Americans as compared to other races. There is currently no FDA cleared diagnostic test for M. genitalium, although a research-use-only TMA assay exists. The aim of our study was to determine the prevalence of M. genitalium in patients presenting to the Oakland County Health Department (OCHD) and determine any differences in prevalence based on sex, age and sexual preference.

Methods: We obtained a total of 5,021 urine specimens during single patient visits to the OCHD between August 1, 2016 and January 31, 2017. Of these, 2,323 were from female subjects and 2,698 were from male subjects. Urine samples were tested for M. genitalium (using a research-use-only TMA assay) as well as C. trachomatis, N. gonorrhea, and T. vaginalis (using FDA approved PCR assays). Each patient also had VDRL titers drawn for syphilis testing.

Results: M. genitalium was the most frequent organism recovered in women with a prevalence of 11.11%, followed by C. trachomatis (7.40%), T. vaginalis (4.43%), N. gonorrhea (2.02%) and syphilis (0.65%). In men, M. genitalium was equally prevalent (12.31%) as C. trachomatis (10.67%), followed by N. gonorrhea (4.86%), T. vaginalis (3.48%) and syphilis (1.93%). All organisms, with the exception of syphilis, were more prevalent in African American men as compared to Caucasian men. No difference in prevalence was seen in women irrespective of race and there was no difference based on sexual orientation.

Conclusion: Our analysis showed that Mycoplasma genitalium is highly prevalent in our study population. This is of particular public health concern as this organism can result in a significant disease burden if left untreated. Azithromycin is the first-line agent against M. genitalium but can result in treatment failure in 13-32% of cases according to recent studies. For this reason, we advocate for the need to test for M. genitalium routinely in symptomatic patients at risk for sexually transmitted diseases.