trachomatisis the most common reportable bacterial infection in the United States [11],M. and long-term sequelae is definitely warranted. == 1. Intro == Mycoplasma genitaliumis a genital tract microorganism [1,2] recognized in approximately 15 to 20% of young women seen in some adolescent health centers, sexually transmitted infection clinics, and emergency departments in the United States [36]. Concordance ofM. genitaliuminfection [1,2,7,8] as well asM. genitaliumsequence type [9] among sexual partners suggests that this bacteria is sexually transmitted. In some populations studied, contamination withM. genitaliumis as common asChlamydia trachomatisamong high risk sexually active women [3,10] and women with clinically suspected pelvic inflammatory disease (PID) [4]. AsC. trachomatisis the most common reportable bacterial infection in the United States [11],M. genitaliumis thus a relatively common contamination.M. genitaliumhas been associated with cervicitis [2,1215] and may play a role in PID, the infection and inflammation of a woman’s upper genital tract [16]. PID is usually frequent among women of childbearing age, diagnosed in approximately 8% of US women and 15% of Swedish women in their lifetime, with over one million U.S. women treated annually [1722]. Major reproductive and gynecologic morbidities result from PID, including infertility, ectopic pregnancy, chronic pelvic pain, and recurrent PID [23]. Although PID has a polymicrobial etiology, withC. trachomatisand/orN. gonorrhoeaeisolated from approximately one-third to one half of cases [5,2427], many PID cases have an unidentified etiology. Although bacterial vaginosis-associated and mycoplasmal organisms have been associated with PID [46,13,25,2732], impartial of gonococcal and chlamydial contamination [4,28], less is known about the etiology, treatment, and sequelae of nongonococcal, nonchlamydial PID. This paper reviews recent evidence for the role ofM. genitaliumin PID and subsequent reproductive and gynecologic outcomes. == 2.Mycoplasma genitaliumLower Genital Tract Contamination == M. genitaliumwas first identified in the early 1980s among men with nongonococcal urethritis [33]. Because the microbe is extremely difficult to culture, only with polymerase chain reaction (PCR) technology has research into the pathogenicity ofM. genitaliumprogressed. Numerous studies have confirmed the role ofM. genitaliumin acute and chronic drug-resistant nongonococcal urethritis [3436]. In women,M. genitaliumhas been positively associated with cervical inflammation and clinically diagnosed cervicitis, although variable case definitions of cervicitis are responsible for some discrepancies in this literature [12]. AsC. trachomatisis a common cause of cervicitis and thus may confound this series of studies, some have excluded patients screening positive forC. trachomatisor have adjusted for it in multivariate analyses. The vast majority of these have demonstrated an independent, significant association betweenM. genitaliumand cervicitis [12]. == 3.Mycoplasma genitaliumand PID == PID typically occurs as microorganisms ascend from the lower genital tract and Norepinephrine hydrochloride through the cervical os, infecting the uterus, fallopian tubes, and ovaries. Thus, cervicitis is usually a common antecedent of PID. BecauseM. genitaliumis associated with cervicitis [2,1315], it is reasonable that it also causes nongonococcal, nonchlamydial PID. Indeed, this organism induces salpingitis in monkeys [37,38], has been found to ascend from the lower to the upper genital tract in a mouse model [39], causes morphologic changes in ciliated fallopian tube cells in vitro [40], and has been detected in fallopian tube tissue in a woman with salpingitis [41]. Further,M. genitaliumhas been shown to adhere to human spermatozoa, and therefore may potentially be carried by motile sperm to the female upper genital tract [42]. M. genitaliumis detected by PCR frequently among women with PID, with rates ranging from 13% to 16% [4,6,43]. Several epidemiologic studies have associatedM. genitaliumwith clinically suspected PID, endometritis, and adnexitis (seeTable 1) [4,6,13,32,41,43,45]. In particular, a handful of studies have examined the relationship betweenM. genitaliumidentified by PCR and either histologically confirmed endometritis or salpingitis among Norepinephrine hydrochloride a populace of women with clinically suspected PID [4,6]. In a study of 115 women presenting to Norepinephrine hydrochloride a sexually transmitted disease medical center in Nairobi, Kenya, women with histologically confirmed endometritis were significantly more likely to haveM. genitaliumidentified by PCR from your cervix and/or endometrium (16% versus Norepinephrine hydrochloride 2%,P= 0.02) [6]. After excluding women with gonococcal or chlamydial contamination, this study exhibited an independent association betweenM. genitaliumand PID [6]. Similarly, in the PEACH study, Haggerty et GNAQ al. reported that 15% (88) of 586 women with clinically suspected PID tested positive forM. genitaliumin the cervix and/or endometrium by PCR. These women were more than twice as likely to have histologically confirmed endometritis at baseline (OR 2.6, 95% CI 1.54.6) as compared to women withoutM. genitaliumidentified at either site, and this relationship remained significant after adjustment for age, race, and gonococcal and chlamydial contamination (adjusted OR 2.0, 95% CI 1.04.2) [4]. == Table 1. ==.