Photo Credit: Dr Microbe

The following is a summary of “Comparison of two testing strategies for Mycoplasma genitalium in emergency department patients across a statewide health system,” published in the April 2024 issue of Emergency Medicine by Johnson, et al.

Mycoplasma genitalium (Mgen) is a sexually transmitted infection (STI) with varying prevalence rates across different populations. While the CDC recommends testing for Mgen in select circumstances, the most appropriate testing strategy for Mgen in emergency department (ED) patients needs to be determined. For a study, researchers sought to assess adherence to CDC recommendations for the management of Mgen in ED patients and evaluate the effectiveness of different testing strategies in facilitating appropriate treatment.

A multicenter, retrospective cohort study was conducted to assess adherence to CDC recommendations for Mgen management in ED patients. The study included patients discharged from 15 ED sites within a health system who were tested for Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis (T. vaginalis), and Mgen. Two cohorts were analyzed: Cohort 1, from May 2022 to July 2022, included mandatory Mgen testing as part of the standard STI testing panel; Cohort 2, from September 2022 to November 2022, had optional Mgen testing based on CDC recommendations. The primary endpoint was the number of subjects treated appropriately for Mgen according to CDC guidelines. Secondary endpoints included the overall prevalence of Mgen, prevalence in patients diagnosed with pelvic inflammatory disease (PID), and baseline characteristics of patients with Mgen-positive.

The percentage of appropriate Mgen treatment did not significantly differ between Cohort 1 (21%) and Cohort 2 (20%) (P > 0.9). However, a significantly higher number of subjects were inappropriately treated for Mgen in Cohort 1. The overall prevalence of Mgen among tested ED patients was 13.1%, with a 2.9% prevalence of pelvic inflammatory disease (PID) in Mgen-positive patients. Additionally, a positive Mgen result was significantly associated with T. vaginalis infection (P = 0.042).

Testing all STI-presenting patients for Mgen may lead to antibiotic overuse, emphasizing the importance of adhering to CDC testing recommendations. While the prevalence of positive Mgen results aligns with previous literature, risk factor analysis can aid in identifying patients for Mgen testing. Based on the study findings, the inclusion of Mgen in the standard ED STI testing panel is not recommended at present.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000123