Association between Mycoplasma genitalium and pelvic inflammatory disease: systematic review




Mycoplasma genitalium; Pelvic inflammatory disease; Pelvic pain; Sexually transmitted diseases; Teaching.


The Mycoplasma genitalium has become one of the most emerging sexually transmitted infections worldwide. When installed, it may be associated with complications such as cervicitis, non-gonococcal urethritis, and endometritis. Furthermore, there is also evidence of the emergence of pelvic inflammatory disease in patients with Mycoplasma genitalium, although there is a scarcity of data on this. Therefore, we aimed to evaluate the existence of an association between Mycoplasma genitalium and pelvic inflammatory disease or pelvic pain. This is a systematic review, developed in January 2023, considering cohort studies, clinical trials, and cross-sectional studies. The PubMed and CINAHL databases were used, as well as the BVS and Google Scholar virtual libraries. Also, the AskMEDLINE platform was searched, using the guiding question. The studies were limited to Portuguese, English and Spanish, and published between 2012 and 2022. Of the 2,413 works found, only five were selected for the final sample. All findings showed an association between Mycoplasma genitalium and pelvic inflammatory disease, although this relationship was quite variable (2.1%-38%). Pelvic pain was also present in the patients tested, although an asymptomatic or oligosymptomatic condition has also been reported in many cases. Although Mycoplasma genitalium represents an important portion of the infections that cause pelvic disease, Chlamydia trachomatis is still the main cause of it. However, new investigations need to be designed in an attempt to elucidate the relationship between the infection and other sexually transmitted infections and common clinical manifestations.


Baumann, L., Cina, M., Egli-Gany, D., Goutaki, M., Halbeisen, F. S., Lohner, G. R., et al. (2018). Prevalence of Mycoplasma genitalium in different population groups: systematic review and meta-analysis. Sex Transm Infect, 94 (4), 255-262.

Bardin, L. (2011). Análise de conteúdo. Edições 70.

Bjartling, C., Osser, S. & Persson, K. (2010). The association between Mycoplasma genitalium and pelvic inflammatory disease after termination of pregnancy. BJOG: An International Journal of Obstetrics & Gynaecology, 17 (3), 261-364.

Bjartling, C., Osser, S. & Persson, K. (2012). Mycoplasma genitalium in cervicitis and pelvic inflammatory disease among women at a gynecologic outpatient service. Am J Obstet Gynecol, 206(6), 1-8.

Broad, C. E., Furegato, M., Harrison, M. A., Pond, M. J., Tan, N., Okala, S., et al. (2021). High prevalence of coinfection of azithromycin-resistant Mycoplasma genitalium with other STIs: a prospective observational study of London-based symptomatic and STI-contact clinic attendees. Sex Transm Infect, 97(1), 63-68.

Centers for Disease Control and Prevention. (2015). Sexually transmitted diseases treatment guidelines. MMWR Recomm Rep., 64: 1-137.

Cina, M., Baumann, L., Egli-Gany, D., Halbeisen, F. S., Ali, H., Scott, P. & Low, N. (2019). Mycoplasma genitalium incidence, persistence, concordance between partners and progression: systematic review and meta-analysis. Sex Transm Infect., 95(5), 328-335.

Curry, A., Williams, T. & Penny, M. L. (2019). Pelvic inflammatory disease: diagnosis, management, and prevention. American Family Physician, 100 (6), 357-364.

Fernández-Huerta, M., Barberá, M. J., Serra-Pladevall, J., Esperalba, J., Martínez-Gómez, X., Centeno, C., et al. (2020). Mycoplasma genitalium and antimicrobial resistance in Europe: a comprehensive review. International Journal of STD & AIDS, 31(3), 190-197.

Haggerty, C. L. (2008). Evidence for a role of Mycoplasma genitalium in pelvic inflammatory disease. Curr Opin Infect Dis, 21(1), 65-69.

Harrison, S. A., Olson, K. M., Ratliff, A. E., Xiao, L., Van Der Pol, B., Waites, K. B. & Geisler, WM. (2019). Mycoplasma genitalium coinfection in women with chlamydia trachomatis infection. Sex Transm Dis, 46(10), e101-e104.

Hart, T., Tang, W. Y., Mansoor, S. A. B., Chio, M. T. W. & Barkham, T. (2020). Mycoplasma genitalium in Singapore is associated with Chlamydia trachomatis infection and displays high macrolide and Fluoroquinolone resistance rates. BMC Infect Dis, 20(1), 314.

Khosropour, C. M., Jensen, J. S., Soge, O. O., Leipertz, G., Unutzer, A., Pascual, R., et al. (2020). High prevalence of vaginal and rectal mycoplasma genitalium macrolide resistance among female sexually transmitted disease clinic patients in Seattle, Washington. Sex Transm Dis, 47(5), 321-325.

Lewis, J., Horner, P. J. & White, P. J. (2020). Incidence of pelvic inflammatory disease associated with mycoplasma genitalium infection: evidence synthesis of cohort study data. Clin Infect Dis, 71(10), 2719-2722.

Lis, R., Rowhani-Rahbar, A. & Manhart, L. E. (2015). Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis, 61, 418–26.

Manhart, L. E., Gaydos, C. A., Taylor, S. N., Lillis, R. A., Hook, E. W. 3rd, Klausner, J. D., et al. (2020). Characteristics of Mycoplasma genitalium Urogenital Infections in a Diverse Patient Sample from the United States: Results from the Aptima Mycoplasma genitalium Evaluation Study (AMES). J Clin Microbiol, 58(7), e00165-20.

Mitchell, C. M., Anyalechi, G. E., Cohen, C. R., Haggerty, C. L., Manhart, L. E. & Hillier, S. L. (2021). Etiology and Diagnosis of Pelvic Inflammatory Disease: Looking Beyond Gonorrhea and Chlamydia. The Journal of Infectious Diseases, 224(2), 29-35.

Munoz, J. L. & Goje, O. J. (2016). Mycoplasma genitalium: an emerging sexually transmitted infection. Scientifica (Cairo), 2016: 7537318.

Ness, R. B., Soper, D. E., Holley, R. L., Peipert, J., Randall, H., Sweet, R. L., et al. (2002). Effectiveness of inpatient and outpatient treatment strategies for women with pelvic inflammatory disease: results from the Pelvic Inflammatory Disease Evaluation and Clinical Health (PEACH) Randomized Trial. Am J Obstet Gynecol, 186(5), 929-937.

Oakeshott, P., Aghaizu, A., Hay, P., Reid, F., Kerry, S., Atherton, H., et al. (2010). Is Mycoplasma genitalium in women the "New Chlamydia?" A community-based prospective cohort study. Clin Infect Dis, 51(10), 1160-6.

Ona, S.; Molina, R. L. & Diouf, K. (2016). Mycoplasma genitalum: an overlooked sexually transmitted pathogen in women? Infect Dis Obstet Gynecol., 2016, 4513089.

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al. (2021). The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ, 372 (71).

Pitt, R., Fifer, H., Woodford, N. & Alexander, S. (2018). Detection of markers predictive of macrolide and fluoroquinolone resistance in Mycoplasma genitalium from patients attending sexual health services in England. Sex Transm Infect, 94(1), 9-13.

Sweeney, S., Bateson, D., Fleming, K. & Huston, W. (2022). Factors associated with pelvic inflammatory disease: a case series analysis of family planning clinic data. Womens Health (Lond), 18.

Shilling, H. S., Garland, S. M., Costa, A. M., Marceglia, A., Fethers, K., Danielewski, J., et al. (2022). Chlamydia trachomatis and Mycoplasma genitalium prevalence and associated factors among women presenting to a pregnancy termination and contraception clinic, 2009-2019. Sex Transm Infect, 98(2), 115-120.

Smieszek, T. & White, P. J. (2016). Apparently-different clearance rates from cohort studies of mycoplasma genitalium are consistent after accounting for incidence of infection, recurrent infection, and study design. PLoS ONE, 11 (2).

Taylor, B. D., Zheng, X., O'Connell, C. M., Wiesenfeld, H. C., Hillier, S. L. & Darville, T. (2018). Risk factors for Mycoplasma genitalium endometritis and incident infection: a secondary data analysis of the T cell Response Against Chlamydia (TRAC) Study. Sex Transm Infect, 94(6), 414-420.

Trent, M., Yusuf, H. E., Perin, J., Anders, J., Chung, S., Tabacco-Saeed, L., et al. Clearance of mycoplasma genitalium and trichomonas vaginalis among adolescents and young adults with pelvic inflammatory disease: results from the Tech-n study. Sex Transm Dis, 47(11), 47-50.

Walker, J., Fairley, C. K., Bradshaw, C. S., Tabrizi, S. N., Twin, J., Chen, M. Y., Taylor, N., et al. (2013). Mycoplasma genitalium incidence, organism load, and treatment failure in a cohort of young Australian women. Clin Infect Dis, 56(8), 1094-100.

Yagur, Y., Weitzner, O., Barchilon Tiosano, L., Paitan, Y., Katzir, M., Schonman, R., et al. (2021). Characteristics of pelvic inflammatory disease caused by sexually transmitted disease - An epidemiologic study. J Gynecol Obstet Hum Reprod, 50(9), 102176.



How to Cite

SILVA, N. L. da .; BITAR, A. A. B.; TROMBETTA , T. C. .; RIBEIRO, A. R.; BENTES, T. K. .; QUEIROZ, Y. S. . .; LIRA NETO, J. C. G. .; FERREIRA, B. de O. Association between Mycoplasma genitalium and pelvic inflammatory disease: systematic review. Research, Society and Development, [S. l.], v. 12, n. 2, p. e8812240030, 2023. DOI: 10.33448/rsd-v12i2.40030. Disponível em: Acesso em: 3 oct. 2023.



Health Sciences