Background: Mycoplasma genitalium is a sexually transmitted infection pathogen. There have been no published studies concerning symptomatology, prevalence data, antibiotic resistance profiling or reports of co-infection with other STIs in pregnant women.

Objective: To describe these characteristics among pregnant women attending prenatal clinics in a large tertiary care center.

Design: Remnant genital samples collected from pregnant women between August 2018 and November 2019 were tested for M. genitalium and Trichomonas vaginalis by the transcription-mediated amplification technique. Specimens with detectable M. genitalium RNA were sequenced for 23S rRNA mutations associated with azithromycin resistance and parC and gyrA mutations associated with resistance to moxifloxacin. Demographic, obstetric and STI co-infection data were recorded.

Results: Of the 719 samples, 41 (5.7 %) were positive for M. genitalium. M. genitalium infection was associated with Black race, Hispanic ethnicity and young age (p= .003, .008 and .004 respectively). M. genitalium infection was also associated with T. vaginalis co-infection and Streptococcus agalactiae (GBS) colonization (p =<0.001 and .002 respectively). Of the 41 positive samples, 26 (63.4%) underwent successful sequencing. Eight (30.8%) had 23S rRNA mutations related to azithromycin resistance. One of 26 (3.8%) positive samples with sequencing results had the gyrA gene mutation and 1 of 18 sequenced samples (5.6%) had the parC gene mutation associated with moxifloxacin resistance.

Conclusions: Prevalence rates of M. genitalium in pregnant women was 5.7%. M. genitalium infection disproportionately affects young Black women co-infected with T. vaginalis. Pregnant women remain at risk for persistent infection with M. genitalium due to decreased azithromycin susceptibility.

After Institutional Review Board approval from the Baylor College of Medicine, all remnant Aptima Multitest clinician-collected endocervical samples from pregnant women presenting to care between August 30, 2018 and November 30, 2019 were placed in the Aptima swab specimen transport tube, stored for up to 30 days and shipped monthly by overnight mail to Marquette University, Milwaukee, WI for M. genitalium 16S rRNA and Trichomonas vaginalis testing by the transcription - mediated amplification technique utilizing Panther System automation (Hologic, Inc., San Diego, CA) as previously described^11-20. Only one sample collected at intake to care was used for each patient presenting obstetrical care and received testing with the Aptima swab for N. gonorrhoeae and C. trachamatis per institutional protocol and guidelines.

M. genitalium positive specimens were shipped to the Public Health Agency of Canada, National Microbiology Laboratory for additional testing. DNA was extracted from the specimens using the MagNA Pure DNA and Viral Nucleic Acid kit (Roche, Laval, Quebec) per manufacturer’s instruction. Specimens with detectable M. genitalium DNA were subsequently analyzed by sequencing the 23S rRNA gene to identify mutations associated with azithromycin resistance and parC and gyrA genes associated with resistance to moxifloxacin.

Demographic variables, obstetrical data, pelvic symptoms consistent with cervicitis (pelvic pressure, vaginal discharge, lower abdominal cramping), and STI co-infection [Neisseria gonorrhoeae, Chlamydia trachomatis, herpes simplex virus, human immunodeficiency virus, Trichomonas vaginalis, human papillomavirus (types 16,18)] Bacterial vaginosis and group B Streptococcus (GBS) colonization data were extracted from the chart and recorded by the investigators. Patient characteristics, co-infection with other STI and M. genitalium resistance profiles were summarized by means with standard deviations, or frequencies with percentages.  Fisher's exact test or the Wilcoxon Rank Sum test was used to determine differences between women positive and negative for M. genitalium in demographic, clinical characteristics, and co-infections with other STIs.  Exact 95% confidence intervals (CIs) were determined for the resistance profiles. STROBE guidelines were followed for the study design, methods and analysis³⁴. All protected health information was removed from discarded samples prior to shipment and all data was entered into a de-identified database using only study numbers to link information at completion of study.

Text in red denotes more collected data since submission.