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Prospective cohort finds 45.8% spontaneous clearance of Mycoplasma genitalium in women seeking pregnancy terminationStudy finds nearly half of vaginal Mycoplasma genitalium infections cleared without treatment

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Key Takeaway
Consider high spontaneous MG clearance and macrolide resistance when evaluating screening in pregnancy termination settings.

This prospective cohort study, conducted at a pregnancy termination center in Bordeaux, France, followed 48 women who tested positive for vaginal Mycoplasma genitalium (MG) out of 1496 tested. The study observed participants without intervention, assessing MG status at 3 and 9 weeks after inclusion. The prevalence of MG at inclusion was 6.3% (94/1496), and 75.7% (53/70) of MG-positive women were asymptomatic. Among the 48 women who attended follow-up, the spontaneous clearance rate throughout the study period was 45.8% (22/48). Lower bacterial load at inclusion was identified as a factor associated with clearance, though specific effect sizes were not reported. Testing of available samples found macrolide resistance in 32.3% (11/34) and fluoroquinolone resistance in 6% (3/50) of cases. Safety and tolerability data were not reported. Key limitations include the observational design, which precludes causal conclusions, and the single-center setting with a specific population of women seeking pregnancy termination. Furthermore, only 48 of the 70 eligible MG-positive women attended follow-up, which may affect the representativeness of the clearance estimate. The practice relevance is restrained; the authors suggest the observed clearance rate and resistance prevalence support arguments against routine MG screening in this specific clinical context, but generalizability to other populations is uncertain.

Researchers in France studied whether a vaginal infection called Mycoplasma genitalium (MG) can clear up on its own without treatment. They followed 48 women who tested positive for MG when they came to a pregnancy termination center. The women did not receive any treatment for the infection.

Over 9 weeks, the study found that nearly half (45.8%) of the women's MG infections went away without any medication. Women who had a lower amount of the bacteria at their first test were more likely to have their infection clear. The study also found that many women with MG (75.7%) had no symptoms, and that some strains of the bacteria were resistant to common antibiotics.

The main reason to be careful with these results is that this was a small, observational study at one center. Only 48 of the 70 eligible women came back for follow-up tests, which could affect the findings. The study suggests that for some women, MG might clear naturally, but more research is needed to understand who this applies to and why.

What this means for you:
A small study found some vaginal MG infections clear without treatment, but more research is needed.

Study Details

EvidenceLevel 5
PublishedApr 2026
View Original Abstract ↓
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.
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