Evidence for a role of Mycoplasma genitalium in pelvic inflammatory disease

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Abstract
Mycoplasma genitalium is a common sexually transmitted pathogen frequently identified among women with pelvic inflammatory disease, the infection and inflammation of a woman's upper genital tract. Although Chlamydia trachomatis and Neisseria gonorrhoeae frequently cause pelvic inflammatory disease, up to 70% of cases have unidentified etiology. This review summarizes recent evidence for M. genitalium's role in pelvic inflammatory disease and subsequent sequelae. PCR studies have demonstrated that M. genitalium is associated with clinically suspected pelvic inflammatory disease, acute endometritis, and adnexitis, independent of gonococcal and chlamydial infection. Most studies have been cross-sectional, although one prospective investigation suggested that M. genitalium was associated with over a 13-fold risk of endometritis. Whether or not M. genitalium upper-genital-tract infection results in reproductive morbidity is unclear, although it has been serologically associated with tubal-factor infertility. Several lines of evidence suggest that M. genitalium is likely resistant to many frequently used pelvic inflammatory disease treatments. Correspondingly, M. genitalium has been associated with treatment failure following cefoxitin and doxycycline treatment for clinically suspected pelvic inflammatory disease. Strong evidence suggests that M. genitalium is associated with pelvic inflammatory disease. Further study of M. genitalium upper-genital-tract infection diagnosis and treatment is warranted.