What is Mycoplasma Genitalium?

Discovered in 1980, mycoplasma genitalium is a bacterium (germ) which lives on the skin cells of the urinary, and genital tracts in the human body, such as the cervix, urethra, and rectum.This micro-organism can eventually cause Sexually transmitted disease.

You can catch it from a person who already has it, by engaging in unprotected sexual activity with them (this also includes the use of sex toys)

It is important to note that, the sex doesn’t have to be penetrative, touching or rubbing of the penis against the vagina, or anus for that matter, can lead to transmission. Other close physical contacts such as; kissing or hugging, and sharing things like baths, towels, swimming pools, or toilet seats, are highly unlikely to cause transmission of the infection.

Mycoplasma Genitalium can cause inflammation of the fragile genital tissue, thus making the genitals more vulnerable to being infected with other STIs, including HIV.

Research has reliably shown that the rates of MG infection are higher in people who have already been infected by other STIs.

That said, however, having MG doesn’t automatically translate into your partner being unfaithful in the past or currently. Rather, it could be, they had it all the while, but only finding out now. MG doesn’t have symptoms. So…

How Common Is Mycoplasma Genitalium?

M genitalium infection is a pervasive cause of STIs globally, with prevalence rates of 0.4% in young adults, in the United States, and 4.5% in the Netherlands.

This infection is more common in young people, especially, those who fall under ages 16-44 years, and people who do not use protection while having sex, especially with multiple partners.

It is approximated that in every 100, sexually active adults, within the above-mentioned age range,1-2 are infected with the bacterium in the UK.

Despite the differences in its prevalence rates from county to country, M genitalium, though silent, has become one of the commonest STIs, holding the second position after C trachomatis in ubiquity.

Of concern, however, is the fact that this infection is asymptomatic, meaning, in most cases, patients have non-specific or non-existent symptoms, making it easy to be ‘ignored’. This is extremely dangerous because, if left untreated M genitalium can silently lead to serious health issues such as; cervicitis, urethritis, and pelvic inflammatory disease, among others.

What Are the Risk Factors for M Genitalium?

M gen is universally transmitted sexually. So, like any other STI, what puts you at a greater risk of being infected with it is if you:

  • Have multiple sex partners, or do not practice safe sex.
  • Smoke. Smoking makes you susceptible to many infections, by lowering immunity (Weakening your body’s ability to fight off infections).
  • Are of non-white ethnicity. This is possibly due to hereditary differences in the immune system.

Do I Need to Be Tested for M gen?

You should go to your doctor, or sexual health clinic for a checkup if you:

  • Have symptoms that resemble those of other STIs, and mostly chlamydia.
  • Are, a man with non-gonococcal urethritis.
  • Are a woman with pelvic inflammatory disease
  • Have a partner who is infected with M genitalium.
  • Are planning to start a family. If you are planning to have a baby, it’s vitally important to know about your health status.

Your doctor will take a sample of your urine, or swab your vagina, cervix, urethra, to be analyzed in a laboratory. A rectal swab may also be needed, for those who engage in anal sex.

However, it is important to note that unlike other STDs, there is no distinct test for M gen, that is FDA (Food and Drug Administration) approved, yet. And because it’s so hard to detect the germ (bacterium), a special test called nucleic acid amplification test(NAAT) may be applied to obtain more conclusive results.

What If I don’t have symptoms? Can I Still Get Tested for M gen?

Currently, and according to international guidelines, it’s universally recommended that the only people to be screened for M gen, are those who have symptoms, or are sexual partners to those who are infected. Doctors are advised against carrying out screening tests on people who don’t have symptoms.

M gen often has no symptoms, and it’s not yet fully comprehended, how the infection progresses to the extent of becoming harmful, even though, it’s likely its chances of doing so, are lesser than that of chlamydia.

The germ (bacterium) has also increasingly developed resistance to some antibiotics, thus necessitating the use of stronger ones, and other interventions, to treat.

This is a big contrast when compared to chlamydia, which is easier to get rid of.

Antibiotics, generally have side-effects. Using stronger ones, only serve to increase the negative effects in people’s stomachs, and overall health. They do not only eradicate the germ, but also kill the good bacteria, which are fundamental in keeping the body healthy.

How Do I know it’s M. genitalium? What Are the Symptoms?

Mycoplasma genitalium is generally asymptomatic, and hardly ever shows any symptoms. This makes the chances of having it, and not knowing, quite high.

That said, some symptoms to look out for are:

Men

The severity of the symptoms will vary from mild to moderate, depending in non-specific factors.

  • Mild irritation, itchiness, stinging or burning sensation or pain when passing urine
  • Colorless or cloudy discharge from the penis.
  • Pain on ejaculation.

Women

  • Bleeding or spotting between periods.
  • Pain in the lower abdomen, which may be due to pelvic inflammatory disease.
  • Discomfort or pain during intercourse.
  • Smelly or unusual discharge from the vagina.

For those practicing anal sex, symptoms may include:

Itching or pain inside the anus, discharging, or sometimes bleeding from the anus.

What Are the Complications Associated with M. genitalium?

Health problems developing from untreated mycoplasma genitalium, mainly results from the impact of the germ (bacterium) on the immune system. (When the immune system has been compromised, or weakened by the infection, then the body has no fighting chance against more aggressive infections)

moreover, the bacterium also appears, to have a significant degree of being harmful to the fallopian tube lining, and can lead to a condition known as salpingitis, which may eventually cause female infertility. However, the most common complications tend resemble those resulting from chlamydia. These complications include;

  • Pelvic inflammatory disease:

This condition occurs in the womb(uterus), and the fallopian tubes in women. Its symptoms may include; pain during sex, lower abdominal pain, fever, and malaise.

Blockage of the fallopian tubes, resulting from the infection, may lead to tubal infertility.

  • Sexually Acquired Reactive Arthritis (SARA):

This may result from untreated urethritis in both men and women. Its symptoms include; pain, stiffness, and swelling in the affected joints. The most affected areas are the knees, ankles, and feet. Other symptoms could include; pain on passing urine, and inflammation of the eye.

  • Epididymo-orchitis:

This condition is characterized by painful swelling, and infection of the testicle(testis), and a tube called epididymis.

It mainly affects men, and has been thought of as a potential cause of male infertility. It cannot be directly linked to this though.

Having other STIs like HIV, increases the chances of you, passing on those other infections.

  • Adverse pregnancy Outcome

Mycoplasma genitalium can also lead to a pregnant woman miscarrying, having a stillbirth, or having a preterm baby.

Furthermore, the antibiotics used to treat M gen may also be unsafe for use during pregnancy, thus it is paramount to volunteer this information, when you talk to your doctor.

Is Mycoplasma Genitalium Preventable?

Just as it applies to most/all other STIs, M gen infection can be prevented by regular use of protection, when having sex, especially with multiple partners.

Female and male Condoms, for example, give you ample barrier protection, by preventing direct genital, to genital contact. However, as much as condoms will limit your chances of catching Mycoplasma genitalium, they won’t give you 100% warranty, that you won’t get it. The surest way to be safe, is to keep off sex for 7 days after you begin your treatment. This also ensures that you don’t infect others.

Do I Need to Let My Partner(s) know I have M. Genitalium?

If you’ve tested positive for mycoplasma genitalium, the honorable, and advisable thing to do, is to let your sexual partner(s) know, so they can make informed choices on how to protect themselves, and others. By getting tested and treated, your partner significantly lowers the risk of passing on the infection. This also ensures you don’t get reinfected with the bacterium, after treatment.

Since there is no way to trace all your sexual partners, and how far back you should go to let them know about your diagnosis, you may follow the recommendations by the chlamydia guidelines which suggest you contact any partner you have had in the previous 6 months.

What’s The Treatment for Mycoplasma Genitalium?

Mycoplasma genitalium is a hard nut to crack. Getting rid of this bacterium can be challenging. Most antibiotics, including the common ones like penicillin kill bacteria by destroying their cell walls. Unfortunately, M gen bacterium does not have cell walls, so these medicines don’t work as effectively on them.

Uncomplicated M gen can be treated using:

Azithromycin

According to the pharmaceutical journal, azithromycin is the first line of defense against Mycoplasma genitalium; even though, this antibiotic is increasingly losing its effectiveness, as the bacterium develops resistance to it.

The resistance could be resulting from misuse, or overuse of the drug’s single dose of 1g; in the treatment of chlamydia, and other unidentified infections of the reproductive organs such as NGU (non-gonococcal urethritis). Azithromycin 1g is not enough to treat mycoplasma genitalium due to its slowness to reproduce.

Treatment with azithromycin should not be repeated, in case the first attempt failed to work. This is because the bacterium will have developed resistance to the drug. Moreover, the experimental use of single-dose azithromycin to treat STIs is no longer applicable.

Doxycycline

This antibiotic doesn’t work very well on its own, against M genitalium, with approximate success rate of 30-40%.

On the other hand, doxycycline , followed closely by a high dose of azithromycin, will effectively reduce the bacterial load, thus improving the success rate of treatment.

It has also been endorsed as the first-choice antibiotic, in the management of urethritis.

A doctor may give you an initial dose of doxycycline, as general treatment for uncomplicated genital infection. However, redoing a doxycycline course is dimmed unnecessary in a confirmed case of mycoplasma genitalium. Azithromycin should be given immediately; preferably within two weeks of the last dose of doxycycline.

Moxifloxacin

Moxifloxacin is preferred to be used as secondary therapy in verified cases of M genitalium with complications, such as; pelvic inflammatory disease and epididymitis, since they require urgent and effective treatment.

It is taken as a daily dose of 400mg, for 7, 10 or 14 days; and has shown higher success rates in curing M gen, in both women and men, and especially, in cases of previous therapy failures.

Despite being very effective against M gen, moxifloxacin has some down side qualities which are worth noting, mainly; adverse side-effects, and high cost.

Alternative Treatments

Other drugs such as pristinamycin, streptogramin, which is antimicrobial, and has been used to treat osteo-articular (bone) infection, can also be used to treat M genitalium infection, where the bacterium has developed resistance to macrolide (like azithromycin), and quinolone (like moxifloxacin)

This drug needs to be taken orally, 4 times per day, making it a little more costly. Access to it is also not easy.

Side-effects and Contraindications

Azithromycin, doxycycline, and moxifloxacin, all can cause undesirable gastrointestinal side effects such as nausea.

Side effects caused by azithromycin, are mainly due to taking higher doses of more than 1g.

For a patient who is already taking medicines like some anti-arrhythmic, and certain antihistamines, great care should be observed when giving a prescription of either azithromycin and moxifloxacin.

In a case where a patient experiences side effects relating to muscles, tendons, bones or even the nervous system, then therapy with either drugs should be halted.

Intricacies involving the liver are generally scarce. However, total contraindication to moxifloxacin is recommended if a patient is hypersensitive to quinolones ,

That said, moxifloxacin remains the most viable treatment option for M genitalium. Furthermore, treatment choices are quite limited.

Treating Mycoplasma Genitalium in Pregnancy

Taking a 500mg oral, daily dose of azithromycin, poses no real danger to an unborn child, or the mother.

However, for pregnant women who have macrolide-resistant infection, it’s unfortunate them, since treatment options are limited in their condition.

The use of moxifloxacin pregnancy is contraindicated (not recommended), while there’s currently no information regarding the use of alternatives such as pristinamycin in pregnancy.

The doctor should promptly explain to their patient, the risks involved when these drugs are used during pregnancy. All in all, the treatment of Mycoplasma genitalium should be withheld, where possible, until after delivery.

Follow-up

Everyone undergoing the treatment for M. genitalium should get retested 3-5weeks after commencing treatment.

This is to determine whether the course of treatment has succeeded in the elimination of M. genitalium. This is because the mere clearance of symptoms can not be completely relied upon. Cases have emerged where, men being treated for NGU (non-gonococcal urethritis), became clinically asymptomatic, but later tested positive for mycoplasma genitalium.

Can I Have Sex Whilst on Treatment for Mycoplasma Genitalium?

It is recommended that you refrain from having intercourse, until you and your partner are completely through with your treatment.

It’s also advisable for women who have pelvic inflammatory disease to avoid having sex until 14 days have passed, after commencement of therapy.

What’s The Prognosis (Outlook) for Mycoplasma Genitalium?

In the antibiotics used for treatment have been successful in eliminating the bacterium, and there are no complications, whatsoever, chances of developing any long-term health problems are highly unlikely.

As suspected, the irreversible tubal damage resulting from PID could affect your fertility. However, there’s no conclusive evidence to show if M. gen causes infertility in men who develop epididymo-orchitis. Research is still ongoing.

Just as in the case of chlamydia, if M gen results in reactive arthritis, then it is likely that it will also be eradicated, as M gen gets treated, even though it will take a little more time to be rid of.

Conclusion

Mycoplasma genitalium is an emerging sexually transmitted infection. It is not yet fully understood how this bacterium develops, but it can be detected using a special test called; nucleic acid amplification test.

Although it is rapidly developing drug resistance against some drugs, mycoplasma genitalium has generally shown quick, and effective response to other antibiotics, even having close to 100% success rates against

On the other hand, if it’s left untreated, Mycoplasma Genitalium can weaken the immune system to an extent that the patient becomes vulnerable to more infections. That aside, it may also lead to some serious health problems.

Contributor: admin