Prospective cohort finds 45.8% spontaneous clearance of Mycoplasma genitalium in women seeking pregnancy termination

OBJECTIVE: To evaluate the spontaneous clearance of Mycoplasma genitalium (MG) and associated factors in women. DESIGN: Prospective cohort. SETTING: Pregnancy termination centre in Bordeaux, France. POPULATION: A cohort of 1496 women seeking pregnancy termination. METHODS: MG was detected using self-collected vaginal swabs obtained prior to abortion. Women with concurrent Chlamydia trachomatis infection or prior intake of antibiotics active against MG were excluded. Demographic, clinical, biological and behavioural data were collected. Follow-up visits were scheduled at 3 and 9 weeks after inclusion, during which self-collected vaginal swabs and sexual behaviour data were collected. MG-positive samples were analysed for bacterial load, mpgB gene typing, and mutations associated with macrolide and fluoroquinolone resistance. MAIN OUTCOME MEASURES: MG negativity at follow-up visits. RESULTS: Among 1496 women tested, 94 (6.3%) were MG-positive. Of these, 70 met the inclusion criteria, and 75.7% (53 of 70) were asymptomatic. The prevalence of macrolide and fluoroquinolone resistance was 32.3% (11 of 34) and 6% (3 of 50), respectively. Forty-eight women attended follow-up. Spontaneous clearance occurred in 45.8% (22 of 48) of cases throughout the study period. Lower bacterial load at inclusion was the only factor associated with clearance. CONCLUSION: The high rate of spontaneous clearance and the substantial prevalence of macrolide resistance support the recommendation against routine MG screening in women presenting for pregnancy termination. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04841408.