# Cumulative burden of Chlamydia trachomatis and Mycoplasma genitalium in the US: implications for screening guidelines and antimicrobial resistance

> **NIH NIH R01** · UNIVERSITY OF WASHINGTON · 2022 · $650,268

## Abstract

ABSTRACT
Significant morbidity and health care costs are associated with Chlamydia trachomatis (CT) and Mycoplasma
genitalium (MG) infections. Each is associated with male and female reproductive tract syndromes, yet each
presents unique challenges for control. CT is the most commonly reported nationally notifiable condition in the
US and is a known cause of pelvic inflammatory disease (PID) and infertility. Despite longstanding control
programs, CT rates are at an all-time high and the utility and cost-effectiveness of CT prevention efforts are
debated. As most CT infections are asymptomatic, our current understanding of the epidemiology and the
effectiveness of CT control programs has depended entirely on case detection through screening, which is only
targeted to select populations (women <25 years and other high risk persons). Much less is known about CT in
women ≥25 who are infrequently screened, and screening is not recommended for men who have sex with
women (MSW). These major gaps in our understanding have limited our ability to effectively target CT prevention
programs to men and women at highest risk of infection. MG is a more recently emerged pathogen, responsible
for 20-30% of male urethritis. There is no national MG surveillance and, despite general agreement that MG
causes male urethritis, there is no consensus about whether it causes sequelae in women. Limited population
based estimates of urogenital MG prevalence exist, yet prevalent infections are often a poor predictor of lifetime
experience of PID and infertility and permit only partial understanding of population-level epidemiology.
Antimicrobial resistance (AMR) in MG is rapidly expanding - MG is one of three bacteria on the CDC's 2019
Watch List of AMR threats - but AMR prevalence estimates are derived from high-risk STD clinic populations
and there are no nationally representative data. A better understanding of the population-level epidemiology of
CT and MG is critical to improving control efforts for each. To achieve this, we will conduct a seroepidemiologic
study in the National Health and Nutrition Examinations Survey (NHANES) 2017-2018 cycle, using a novel
serologic assay for CT that differentiates IgG isotypes to distinguish recent from distant infection, and a more
sensitive and specific seroassay for MG. We will also identify AMR in urine specimens from MG-positive persons
in NHANES 2017-2018. Finally, we will develop an individual-based CT and MG transmission dynamics model.
Using these outputs, we will (1) estimate the lifetime prevalence of CT in US men and characterize factors
associated with recent versus past infection among men and women; (2) estimate the seroprevalence and
correlates of MG infection in US men and women, determine the association between prior MG infection and
self-reported PID and infertility, and estimate prevalence and correlates of macrolide and quinolone resistance
in MG; (3) evaluate the impact of CT and MG screening scenarios on reprod...

## Key facts

- **NIH application ID:** 10397644
- **Project number:** 5R01AI161019-02
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Lisa E Manhart
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $650,268
- **Award type:** 5
- **Project period:** 2021-05-01 → 2026-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10397644

## Citation

> US National Institutes of Health, RePORTER application 10397644, Cumulative burden of Chlamydia trachomatis and Mycoplasma genitalium in the US: implications for screening guidelines and antimicrobial resistance (5R01AI161019-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10397644. Licensed CC0.

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