Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019.

BACKGROUND: Risk of pelvic inflammatory disease associated with Chlamydia trachomatis and Mycoplasma genitalium is increased after termination of pregnancy (TOP) and may be increased after insertion of intrauterine devices (IUDs). Screening prior to these procedures is recommended only for C. trachomatis. We examined C. trachomatis and M. genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception service over 10 years. METHODS: Retrospective analysis of clinical data collected from 17 573 women aged 15-45 years in 2009-2019 and for 266 M. genitalium positive women tested for macrolide resistance-associated mutations in 2016-2019. RESULTS: C. trachomatis and M. genitalium prevalence was 3.7% and 3.4%, respectively. In multivariable analyses, shared risk factors were younger age (p<0.001, for both C. trachomatis and M. genitalium), socioeconomic disadvantage (p=0.045 and p=0.008, respectively) and coinfection (p<0.001, for both sexually transmitted infections), with 10.1% of C. trachomatis positive women also positive for M. genitalium. Additional risk factors were earlier year of visit (p=0.001) for C. trachomatis and for M. genitalium residing outside a major city (p=0.013). The proportion of M. genitalium infections tested between 2016 and 2019 with macrolide resistance-associated mutations was 32.7%. CONCLUSIONS: Given the high level of antimicrobial resistance and the prevalence of coinfection, testing C. trachomatis positive women for M. genitalium could be considered in this setting to prevent further spread of resistant infections. Further research is required into the causal link between M. genitalium and pelvic inflammatory disease in women undergoing TOP and IUD insertion.

Long-term trends of Chlamydia trachomatis in a clinic population at the Royal Women's Hospital, Melbourne.

BACKGROUND: Chlamydia trachomatis (C. trachomatis) prevalence has been reported to be increasing. Whether this is a true increase over time or confounded by increases in testing and/or use of more sensitive assays is to be determined. MATERIALS AND METHODS: One laboratory service has been detecting C. trachomatis for the past 30 years within the Royal Women's Hospital Melbourne. We conducted a retrospective audit of records over the period 1986-2016 from a clinic population routinely offered chlamydia screening. These were women presenting for family planning advice (termination of pregnancy, intrauterine device insertion or considered at high risk), who underwent chlamydia testing in the context of various diagnostic assays used over this time period. Assays utilised included culture, enzyme immunoassay (EIA), DNA probe, and nucleic acid amplification testing (NAAT). Non-parametric test for trend was used to determine significant differences between prevalence estimates across ordered groups. Least squares regression was conducted to describe a linear trend matching known data points. RESULTS: Overall, there was no significant change for chlamydia prevalence which was 2.2%, in the 30-year study period (P = 0.7). Over time diagnostic assays changed from culture, to EIA, DNA probe, to the more sensitive NAAT. The bulk of the positives were in women under 25 years of age (57%). CONCLUSION: Chlamydia prevalence has been stable over 30 years, remaining a problem in young women. Screening for those at risk needs underscoring in a national sexual health program.