Utility of Urine, Vaginal, Cervical, and Rectal Specimens for Detection of Mycoplasma genitalium in Women

Abstract

This study assessed the utility of urine, vaginal, cervical, and rectal specimens for the detection of Mycoplasma genitalium in women by using our laboratory-developed PCR assay. The relative sensitivity was 85.7% for the vaginal swab specimen, 74.3% for the endocervical swab specimen, 61.4% for the urine specimen, and 24.3% for the rectal swab specimen.The diagnosis of sexually transmitted diseases (STDs) is increasingly being made using laboratory specimens that patients can collect themselves, such as urine in men and women and vaginal swabs in women. These self-collected specimens have proven useful for reliably detecting Chlamydia trachomatis and Neisseria gonorrhoeae in both men and women by using nucleic acid amplification tests (NAATs) (2, 7).Mycoplasma genitalium is strongly associated with nongonococcal urethritis in men, and its clinical significance in women and the determination of its role as a sexually transmitted agent are receiving growing attention (5, 8). Because there is currently no approved and commercially available diagnostic test for the detection of M. genitalium, clinical studies of M. genitalium infections use local laboratory-developed PCR tests to diagnose infection (11). Regardless of which NAAT is used, the determination of optimal specimen types for the detection of the organism under different circumstances is important.As part of a study of the prevalence and risk factors for M. genitalium among women, conducted in STD clinic patients in New Orleans, we assessed the utility of urine, vaginal, cervical, and rectal specimens for the detection of M. genitalium in women by using a previously described PCR assay developed in our laboratory (9, 10).Women age 18 or older who attended the New Orleans STD clinic for any reason between 28 May 2003 and 26 February 2004 were approached for inclusion in the study and were enrolled after completing the informed consent process. The study was approved by the institutional review board of the Louisiana State University Health Sciences Center. Pregnant women, women with a history of hysterectomy, and those who reported using antibiotics in the past 3 months were excluded from participation.After obtaining informed consent, a complete sexual behavior, STD, obstetric, and gynecologic history was obtained from each study participant and recorded in a standardized form, along with the patient's demographic information. To detect M. genitalium, four laboratory specimens were obtained in the following order. A first-void urine specimen was collected prior to performance of a pelvic examination and kept at 4°C before transport to the laboratory. Following insertion of a nonlubricated speculum into the vagina, a vaginal swab was obtained from the posterior fornix. After cleaning the face of the cervix, an endocervical swab was obtained. A rectal swab was obtained last. Each of the three swabs was placed in a dry transport tube and held at 4°C prior to transport to the laboratory at the end of the day.Following DNA purification, an M. genitalium-specifi...

Mycoplasma genitalium Infection Is Associated with Microscopic Signs of Cervical Inflammation in Liquid Cytology Specimens

“…Previous studies have shown that vaginal swabs may have a greater relative sensitivity for M. genitalium detection than cervical swabs (45,46), and a combination of these sites yields a sensitivity of more than 95% (45). Liquid cytology specimens predominately contain squamous cells of the ectocervix, but because the anatomical target of sampling is the transition zone between the ectocervix and endocervix, columnar cells of the endocervix are also present.…”

Use of Nucleic Acid Amplification Testing for Diagnosis of Anorectal Sexually Transmitted Infections

“…In a study of 500 men attending a sexually transmitted disease (STD) clinic, the prevalence of M. genitalium was 5.4% (5). Lillis et al (18) reported the prevalence of M. genitalium in rectal swabs from 400 females to be 4.3%.…”

Urogenital Mycoplasmosis and Pregnancy

“…For M. genitalium the use of more than one specimen may significantly improve the diagnostic sensitivity. Lillis et al [30] found that the single best specimen for the detection of M. genitalium infection was vaginal swab specimen, followed in order of decreasing relative sensitivity by endocervical swab specimen (74.3%), urine specimen (61.4%), and rectal swab specimen (24.3%).…”

“…Research has also shown that self-collected vaginal swabs are equal to clinician-collected vaginal swabs for diagnosis of C. trachomatis and N. gonorrhoeae, and there is no reason to doubt that the same would be true for M. genitalium [30].…”