Systematic Review and Meta-analysis of the Association Between Mycoplasma Genitalium and Pelvic Inflammatory Disease (PID)

Abstract

Abstract Background Differences in opinion concerning the contribution of Mycoplasma genitalium to pelvic inflammatory disease (PID) has resulted in inconsistencies across global testing and treatment guidelines. We conducted a systematic review and meta-analysis to determine the association between M. genitalium and PID and M. genitalium positivity within PID cases to provide a contemporary evidence base to inform clinical practice (PROSPERO registration: CRD42022382156). Methods PubMed, Embase, Medline, and Web of Science were searched to 1 December 2023 for studies that assessed women for PID using established clinical criteria and used nucleic acid amplification tests to detect M. genitalium. We calculated summary estimates of the (1) association of M. genitalium with PID (pooled odds ratio [OR]) and 2) proportion of PID cases with M. genitalium detected (pooled M. genitalium positivity in PID), using random-effects meta-analyses, with 95% confidence intervals (CI). Results Nineteen studies were included: 10 estimated M. genitalium association with PID, and 19 estimated M. genitalium positivity in PID. M. genitalium infection was significantly associated with PID (pooled OR = 1.67 [95% CI: 1.24–2.24]). The pooled positivity of M. genitalium in PID was 10.3% [95% CI: 5.63–15.99]. Subgroup and meta-regression analyses showed that M. genitalium positivity in PID was highest in the Americas, in studies conducted in both inpatient and outpatient clinic settings, and in populations at high risk of sexually transmitted infections. Conclusions M. genitalium was associated with a 67% increase in odds of PID and was detected in about 1 of 10 clinical diagnoses of PID. These data support testing women for M. genitalium at initial PID diagnosis.