(P465) Bacterial vaginosis and Mycoplasma genitalium among women with cervicitis over a decade

Background: Cervicitis is traditionally associated with Chlamydia trachomatis and Neisseria gonorrhoeae. There is evidence to indicate both Mycoplasma genitalium and bacterial vaginosis (BV) are associated with cervicitis, but international guidelines inconsistently recommend testing for these infections. We aimed to describe the contribution of, and trends in, genital infections to cervicitis over a decade, to inform testing and treatment practices.

Methods: We conducted a retrospective case-series to determine the number of cervicitis cases diagnosed with genital infections among women attending the largest public sexual health service in Australia. Electronic medical records were extracted for all cervicitis cases attending the Melbourne Sexual Health Centre between 1st March 2011-1st March 2021. We determined the proportion of cervicitis cases with one or more genital infections detected, and trends in testing and detection of each infection over time.

Results: Of 813 cervicitis cases diagnosed over a decade, 226/729 (31%, 95%CI:28%-35%) had BV, 163/809 (20%, 95%CI:17%-23%) C. trachomatis, 48/747 (6%, 95%CI:5%-8%) M. genitalium, and 13/793 (2%, 95%CI:1%-3%) N. gonorrhoeae. Of the 665 (81.8%) cases tested for all four infections, 268 (40.3%) had one infection detected and 73 (11.0%) had >1 infection detected; BV and C. trachomatis accounted for 58.9% of coinfections (n=43/73). M. genitalium and BV testing was slightly lower (90-92%) compared to testing for C. trachomatis and N. gonorrhoeae ( >97%). The proportion of cases tested for M. genitalium increased from 84% in 2011 to 96% in 2019 (Ptrend=0.006), with M. genitalium-detection in cervicitis increasing from 3% to 7% (Ptrend=0.046). The proportion with cervicitis tested for BV (90%) did not change overtime, but detection increased from 32% to 45% (Ptrend< 0.001).

Conclusion: Over the past decade, BV emerged as the most frequently detected infection in women with cervicitis in our clinic population, often as the sole infection detected. Whilst C. trachomatis remained common among cervicitis cases, M. genitalium was more commonly detected than N. gonorrhoeae. Understanding the evolving contribution of genital infections to cervicitis globally and regionally is essential to informing relevant testing and treatment practices, to create consistency across guidelines and reduce confusion for clinicians, and lastly to improve targeted treatment strategies and reduce antibiotic misuse.