Mycoplasma Genitalium - Symptoms

Understanding Mycoplasma Genitalium: A Comprehensive Overview

Mycoplasma genitalium is a sexually transmitted bacterial pathogen of the urogenital tract. It causes a significant portion of urethritis in men (about 15–20% of nongonococcal urethritis cases) and is linked to cervicitis and pelvic inflammatory disease (PID) in women​. Most infections​ are asymptomatic, and so the organism can spread unknowingly.

The prevalence of Mycoplasma genitalium in high-risk populations can be 10–25%​. There has been increasing M. genitalium resistance to antibiotics, which has prompted public health authorities to consider M. genitalium as an emerging sexually transmitted infection (STI) of concern.

The following sections describe in detail the clinical features, causes, and management of M genitalium infection.

What are the Symptoms of Mycoplasma Genitalium?

Most people with Mycoplasma genitalium have no symptoms. When symptoms occur, they resemble other sexually transmitted infections. Key clinical findings include:

Asymptomatic Infection

A large proportion of infected men and women report no symptoms.

Men

1. genitalium can cause urethritis (inflammation of the urethra), referred to with urethral discharge and burning on urination. Men may notice a clear or cloudy discharge from the penis.

Women

In women, M. genitalium can cause cervicitis. This can cause symptoms such as:

• Abnormal vaginal discharge
• Genital irritation or pain
• Pain or difficulty with urination or defecation
• Lower abdominal discomfort (sometimes)

Since these symptoms overlap with chlamydia and gonorrhea, diagnosis requires specific testing.

Complications

Untreated, the infection can spread in women, leading to conditions like:

• Pelvic inflammatory disease (PID)
• Scarring of the fallopian tubes
• Ectopic pregnancy
• Chronic pelvic pain
• Infertility

The chronic health effects of untreated infection in men are not well defined.

What Causes Mycoplasma Genitalium Symptoms?

Mycoplasma genitalium is a small bacterium (a member of the Mycoplasma family) that tends to attack the mucous membranes of the genital tract. It has no cell wall and is therefore not detectable by the standard Gram stain. Also, it is inherently resistant to the penicillin family of antibiotics.

This bacterium is transmitted almost exclusively through sexual contact. Spread is mainly by vaginal and anal intercourse with an infected partner (transmission by oral sex is possible but appears to be uncommon).

People can transmit M. genitalium even if they are well, and many infections are asymptomatic. The infection does not spread by casual contact (touching, hugging, sharing toilets or towels).

What are the Risk Factors Of Mycoplasma Genitalium?

Risk factors for acquiring Mycoplasma genitalium symptoms are similar to those for other sexually transmitted infections. These include:

1. Unprotected Sex : Vaginal or anal intercourse without a condom with an infected partner greatly increases risk. Condoms are effective in preventing transmission of M. genitalium. Furthermore, men who engage in sexual activity with other men may be at risk of rectal M. genitalium infections, which are asymptomatic.
2. Multiple or New Sexual Partners : Having more sexual partners or a new partner means you are more likely to run into someone with an infection. Individuals with casual or concurrent partnerships are at higher risk. M. genitalium is often silent, so having a steady partner who doesn’t know that they are carrying the infection is also at risk.
3. History of Other STIs : Having a past or current history of chlamydia, gonorrhea, or another STI suggests behavior or exposure that raises M. genitalium risk. This bacterium is commonly misdiagnosed as chlamydia or gonorrhea.

How are Mycoplasma Genitalium Symptoms Diagnosed?

Routine tests, such as Gram stain or culture, cannot detect Mycoplasma genitalium symptoms. Molecular testing (NAAT/PCR) is required because the culture is impractical (it takes weeks to grow).

• The typical diagnostic approach involves using nucleic acid amplification tests (NAAT) on urine or swab samples. A clinician will usually collect a first catch urine sample or a urethral swab in men; a vaginal or cervical swab in women.
• Polymerase chain reaction (PCR) assays cleared by the FDA are available for male and female genital specimens. Genital or (if indicated) rectal testing is done, and extragenital routine screening is not customary.
• According to the CDC recommendations, testing for Mycoplasma genitaliumshould be considered for individuals who continue to experience persistent or recurring symptoms after being treated for other common STIs.
• For instance, men with persistent nongonococcal urethritis on treatment or women with symptomatic repeated cervicitis or PID should be tested.
• Mycoplasma genitalium testing is performed when chlamydia or gonorrhea therapy fails to improve in patients. As of now, asymptomatic screening of individuals or broad population screening is not recommended.
• Results usually take a few days, and a positive result confirms infection and guides treatment.

How are Mycoplasma Genitalium Symptoms Treated?

Mycoplasma genitalium treatment needs special consideration for resistant strains, especially to azithromycin. According to the CDC, global macrolide resistance markers may be >50%, fluoroquinolone (e.g. moxifloxacin) resistance is lower but is also rising. Therefore, therapy is offered in two stages to maximize cure rates.

Current CDC recommendations (2021) are as follows:

1. If Resistance Testing is Available: Inspect whether the infecting strain is macrolide sensitive or resistant.
   1. If Macrolide Sensitive: Doxycycline (100 mg twice daily for 7 days), then extended dose azithromycin (1 g orally on day 1 followed by 500 mg once daily for 3 days).
   2. If Macrolide-resistant: Doxycycline for 7 days, followed by moxifloxacin (400 mg orally once daily for 7 days).
2. If Resistance Testing is Not Available: Theempiric regimen is doxycycline 100 mg twice daily for 7 days, then moxifloxacin 400 mg once daily for 7 days. This is the recommended sequence as most strains are not susceptible to azithromycin, and as a result, proceeding to moxifloxacin gives the greatest chance of cure.
3. Regimen Alternative:If moxifloxacin is contraindicated or unavailable, the alternative regimen is doxycycline 7 days followed by azithromycin 2.5 g over all (same dose as above), followed by a test of cure 3 weeks after therapy. Since this approach has lower success rates due to high resistance, it is only used when there is no other option.

Here are some additional points to remember in this regard:

• Healthcare providers must make sure patients finish the complete course of treatment and never use azithromycin exclusively.
• Generally, patients start to feel better after a few days of finishing the antibiotics.
• However, if symptoms don't resolve within a few days of treatment, further evaluation is needed.
• Sex partners of infected individuals should also be managed; ideally, they should be tested for M. genitalium and, if they test positive, treated.
• Providers can offer the same antibiotics to partners to lower the risk of reinfection if partner testing is not possible.

How to Prevent Mycoplasma Genitalium?

There is no vaccine for Mycoplasma genitalium, so prevention relies on safe sexual practices and prompt treatment of infections. Key preventive measures include:

• Abstinence or Mutual Monogamy:The only sure way to prevent M. genitalium is to abstain from sexual contact. Practically, a long-term mutually monogamous relationship with a partner who has tested negative reduces risk significantly.
• Condom Use:Consistent and correct use of latex condoms during vaginal and anal sex greatly reduces the risk of transmission. Condoms should be used from start to finish of intercourse.
• Routine Screening:People who have new or multiple partners should have regular sexual health screenings for common STIs. It also provides an opportunity for partners to share STI history and recent test results to identify who needs to be tested.

Early diagnosis and treatment are essential because untreated Mycoplasma genitalium in women can lead to serious reproductive complications. In short, practising safer sex and seeking timely medical care for any STI symptoms are the best ways to prevent Mycoplasma genitalium infection and its consequences.

Also, having a comprehensive health insurance plan can help you access quality medical treatment without delay, thus enhancing the chances of positive outcomes.   

Call Star Health now for further guidance!