title: Abnormal vaginal pH and Mycoplasma genitalium infection.
abstract: OBJECTIVE
  Mycoplasma genitalium (MG) is a sexually transmitted pathogen linked to female morbidity, but testing for MG is not standardized. We aimed to determine which point-of-care (POC) vaginal tests could predict MG infection.
  
  
  METHODS
  A cross sectional study recruited sexually active adolescent women, aged 14-22 y (n = 217) from an urban medical center.
  
  
  METHODS
  Vaginal swabs were POC tested for pH, amines, clue cells, sialidase, and Trichomonas vaginalis (TV). MG was detected by research-use-only transcription mediated amplification (TMA) assay. Presence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) were confirmed using TMA. Three criteria were required for diagnosis of clinical BV: pH > 4.5, presence of amines, and >20% clue cells. Associations were assessed using logistic regression (LR).
  
  
  RESULTS
  TMA detected MG in 30 (14%), CT in 49 (23%), and NG in 21 (10%) of the samples tested. POC vaginal tests were positive for TV in 21%, amines in 52%, clue cells in 33%, sialidase in 22%, pH > 4.5 in 56%, and clinical BV in 19% of the samples tested. Using LR, pH > 4.5 was a predictor of MG (odds ratio 4.4, P < .05). Of 131 women without clinical BV or TV, 25% of those with pH > 4.5 had MG, compared to 9% of those with pH ≤ 4.5 (P = .02).
  
  
  CONCLUSIONS
  Until standardized, approved testing for MG is available, pH may be a useful indicator to suspect MG, especially in the absence of BV and TV.
authors.affiliation: Division of Pediatric and Adolescent Gynecology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. jill.huppert@cchmc.org
authors.forename: Jill S
authors.initials: JS
authors.lastname: Huppert
authors.forename: Justin R
authors.initials: JR
authors.lastname: Bates
authors.forename: Akilah F
authors.initials: AF
authors.lastname: Weber
authors.forename: Nicole
authors.initials: N
authors.lastname: Quinn
authors.forename: Charlotte A
authors.initials: CA
authors.lastname: Gaydos
mesh_terms: D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D006863:Hydrogen-Ion Concentration; D016015:Logistic Models; D009175:Mycoplasma Infections / Q000175:diagnosis*; D045704:Mycoplasma genitalium / Q000302:isolation & purification*; D012307:Risk Factors; D014621:Vagina / Q000737:chemistry* / Q000382:microbiology*; D014626:Vaginal Smears; D055815:Young Adult