Should we screen for the sexually-transmitted infection Mycoplasma genitalium? Evidence synthesis using a transmission-dynamic model

Ruthie Birger*, John Saunders, Claudia Estcourt, Andrew John Sutton, Catherine H. Mercer, Tracy Roberts, Peter J. White*

*Corresponding author for this work

Research output: Contribution to journalArticle

36 Downloads (Pure)

Abstract

There is increasing concern about Mycoplasma genitalium as a cause of urethritis, cervicitis, pelvic inflammatory disease (PID), infertility and ectopic pregnancy. Commercial nucleic acid amplification tests (NAATs) are becoming available, and their use in screening for M. genitalium has been advocated, but M. genitalium’s natural history is poorly-understood, making screening’s effectiveness unclear. We used a transmission-dynamic compartmental model to synthesise evidence from surveillance data and epidemiological and behavioural studies to better understand M. genitalium’s natural history, and then examined the effects of implementing NAAT testing. Introducing NAAT testing initially increases diagnoses, by finding a larger proportion of infections; subsequently the diagnosis rate falls, due to reduced incidence. Testing only symptomatic patients finds relatively little infection in women, as a large proportion is asymptomatic. Testing both symptomatic and asymptomatic patients has a much larger impact and reduces cumulative PID incidence in women due to M. genitalium by 31.1% (95% range:13.0%-52.0%) over 20 years. However, there is important uncertainty in M. genitalium’s natural history parameters, leading to uncertainty in the absolute reduction in PID and sequelae. Empirical work is required to improve understanding of key aspects of M. genitalium’s natural history before it will be possible to determine the effectiveness of screening.
Original languageEnglish
Article number16162
Number of pages13
JournalScientific Reports
Volume7
DOIs
Publication statusPublished - 23 Nov 2017

    Fingerprint

Keywords

  • sexually transmitted infections
  • dynamic modelling
  • Mycoplasma genitalium

Cite this

Birger, R., Saunders, J., Estcourt, C., Sutton, A. J., Mercer, C. H., Roberts, T., & White, P. J. (2017). Should we screen for the sexually-transmitted infection Mycoplasma genitalium? Evidence synthesis using a transmission-dynamic model. Scientific Reports, 7, [16162]. https://doi.org/10.1038/s41598-017-16302-8