摘要：Objectives. We sought to determine the prevalence of and risk factors associated with Mycoplasma genitalium infection in a nationally representative sample of young adults in the United States. Methods. Urine specimens from 1714 women and 1218 men who participated in Wave III of the National Longitudinal Study of Adolescent Health (N=14322) were tested for M genitalium . Poststratification sampling weights were used to generate nationally representative estimates. Results. The prevalence of M genitalium was 1.0% compared with 0.4%, 4.2%, and 2.3% for gonococcal, chlamydial, and trichomonal infections, respectively. No M genitalium –positive individuals reported symptoms of discharge. M genitalium prevalence among those who reported vaginal intercourse was 1.1% compared with 0.05% among those who did not. In multivariate analyses, M genitalium prevalence was 11 times higher among respondents who reported living with a sexual partner, 7 times higher among Blacks, and 4 times higher among those who used condoms during their last vaginal intercourse. Prevalence of M genitalium increased by 10% for each additional sexual partner. Conclusions. M genitalium was more prevalent than Neisseria gonorrhoeae but less prevalent than Chlamydia trachomatis , and it was strongly associated with sexual activity. Adolescents and young adults are disproportionately affected by sexually transmitted infections (STIs) and have the highest rates of Chlamydia trachomatis and Neisseria gonorrhoeae infections. 1 Urethritis among men and endocervicitis among women are typically attributed to infection with either of these 2 bacterial STIs and sometimes with Trichomonas vaginalis. 2 , 3 Infection with these organisms can lead to serious sequelae, such as chronic pelvic pain, ectopic pregnancy, infertility, and increased risk for HIV transmission. 3 – 7 In many studies, however, only 30% to 40% of cervicitis cases have been associated with known pathogens, 8 – 10 and etiology could not be identified in up to 50% of urethritis cases, 2 which suggests the existence of other pathogenic organisms. Mycoplasma genitalium, a recently identified bacterium, is receiving increased attention as a potential cause of both these STI syndromes, yet it is still relatively understudied, and no population-level data on prevalence or risk factors exist. M genitalium was first cultured in the early 1980s from the urethral exudates of 2 men with nongonococcal urethritis. 11 Despite this initial isolation, the fastidious nature of M genitalium makes culture extremely difficult, and it was not until the development of DNA amplification assays 12 , 13 that epidemiological studies of the association between M genitalium and disease syndromes could be undertaken. Since that time, all but 1 14 of the studies that used polymerase chain reaction (PCR) testing to detect M genitalium among men have reported a strong and significant association with non-gonococcal urethritis. 15 – 24 The data available from fewer studies of women suggest that M genitalium also is associated with cervicitis, 25 – 29 endometritis, 30 pelvic inflammatory disease (PID), 31 and tubal factor infertility. 32 Most studies of M genitalium have been conducted in specialized populations (usually sexually transmitted disease [STD] clinics) and, although these groups are ideal for studying potentially new sexually transmitted organisms, they likely overestimate the prevalence in the general population. Furthermore, the high background level of many risk behaviors among STD clinic patients may mask or diminish the association of such factors with organisms identified in these individuals. 33 Finally, most STD clinic attendees are sexually active, which makes it virtually impossible to determine whether, and to what extent, sexual activity is associated with newly identified potential pathogens. Thus, we tested young adults who participated in Wave III of the National Longitudinal Study of Adolescent Health (Add Health) for M genitalium to (1) generate population prevalence estimates of M genitalium among young adults aged 18 to 27 years in the United States, (2) identify sociobehavioral correlates of infection in the general population, and (3) confirm that M genitalium is sexually transmitted.
