One possible explanation for the high rates of M. genitalium in African sex workers is that HIV is highly prevalent in Africa, and HIV and M. genitalium co-infection is common.

As you can see in this slide, in PID populations in both the U.S. and Kenya, endometrial M. genitalium is much more common among HIV seropositive women as compared to HIV seronegative women.

Whether or not HIV infection affects susceptibility to M genitalium infection and disease, or whether it serves as a marker for high risk exposure will require further investigation. It is certainly possible that HIV might increase the susceptibility for M. genitalium infection. Thus, they may be at greater risk of mycoplasmal PID. This is important to consider in the context of global reproductive health, given the high rates of HIV in sub-Saharan Africa.