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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.A cross sectional study recruited sexually active adolescent women, aged 14-22 y (n = 217) from an urban medical center.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: pH4.5, presence of amines, and20% clue cells. Associations were assessed using logistic regression (LR).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).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.

potential. Surgical management: Decision to perform feminizing vs. masculinizing surgery is influenced by the degree of masculinization of the external genitalia and the projected effectiveness of sex assignment including functionality and potential for future fertility. In XY gonadal dysgenesis, surgery should be considered in cases of severe virilization and be performed in conjunction, when appropriate, with repair of the common urogenital sinus. A second surgery to create a functional vagina should be performed after puberty when the patient is motivated to self-dilate and/or is sexually active. FSH and hCG stimulation tests suggestive of ovotestes avoid gonadal biopsy; dysgenetic gonads can be removed after puberty when the risk of malignant transformation is relevant. Hormone replacement therapy: HRT should mimic endogenous hormone production in normal adolescent females. Initiate therapy around age 12 to achieve breast development, support maturation of secondary sex characteristics, and attain optimal bone density. Start with a low dose estrogen; double dose at 3 to 6 months and again 3 months later. After 2 years of unopposed estrogen therapy, add progesterone to achieve optimal breast development irrespective of the presence or absence of a uterus. Treatment should continue until the expected age of menopause. Androgen therapy is not indicated. Discussion: XY gonadal dysgenesis invariably leads to female sex assignment however, the cases presented illustrate potential diagnostic and management difficulties. Systematic laboratory testing and imaging allow early diagnosis and minimize patient and parental frustration. Appropriately timed surgeries minimize the need for additional corrective procedures so that functionality is maximized. Non-surgical diagnostic modalities are consistent with new approaches that seek less invasive interventions. Appropriately timed HRT results in satisfactory development of secondary sex characteristics and minimizes the psychosocial stressors patients face.