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EijaHiltunen-Back

Mycoplasma Genitalium Infection

Essentials

  • Sexually transmitted
  • The bacterium Mycoplasma genitalium has been known for long, but its significance as a pathogen has been confirmed over the recent years.
  • Must be considered in the differential diagnosis of urethritis and cervicitis where the aetiology of symptoms is unclear after chlamydia Chlamydia and gonorrhoea Gonorrhoea have been excluded.
  • Asymptomatic people should not be screened.
  • Encountered in about 5% of patients attending sexually transmitted diseases clinics in the Nordic countries.
  • Macrolide- and quinolone-resistant strains have become more common, posing a challenge to treatment.

Aetiology and clinical picture

  • Mycoplasma genitalium is the smallest known bacteria.
  • Clinical picture resembles that of Chlamydia infection.
  • The incubation time is unknown, probably months.
  • Asymptomatic infections are common.
  • Mycoplasma causes urethritis in men, cervicitis in women, and it may also cause pelvic inflammatory disease Pelvic Inflammatory Disease (Pid).
  • Can cause proctitis symptoms.

Diagnosis

  • Detection of the nucleic acid from a mucous membrane or first-void urine sample
  • A sensitivity test can determine the sensitivity of a strain to macrolides (azithromycin) or fluoroquinolones (moxifloxacin). This would avoid unnecessary antimicrobial treatments.
  • The sample is recommended to be taken only in symptomatic patients when tests for chlamydial and gonococcal infections as well as clean-voided urine have proven negative.
    • particularly of men with unclear urethritis (urethral discharge and burning on urination)
    • of women with lower abdominal pain, burning on urination and increased leucorrhoea
    • if a permanent sexual partner has been diagnosed with Mycoplasma genitalium infection.

Treatment

  • Strains resistant to macrolides (> 30%) and, increasingly, also quinolones are a problem.
  • In new European practice guidelines, first-line treatment is azithromycin, 500 mg on the first day and 250 mg daily from day 2 to day 5.
    • The efficacy of azithromycin is 85-95%.
  • If azithromycin treatment fails or the strain is known to be resistant to it, moxifloxacin 400 mg once daily for 7 days is used (taking into account the warnings related to the medication).
  • A follow-up sample 4 weeks after the treatment is recommended only if the symptoms persist.
  • Permanent sexual partner should be investigated and treated simultaneously with the same antimicrobial drug as the patient.
  • Unprotected sex is to be avoided during the treatment.

    References

    • Jensen JS, Cusini M, Gomberg M, et al. 2021 European guideline on the management of Mycoplasma genitalium infections. J Eur Acad Dermatol Venereol 2022;36(5):641-650 [PubMed]
    • The International Union against Sexually Transmitted Infections (IUSTI) http://iusti.org/treatment-guidelines/
    • Lis R, Rowhani-Rahbar A, Manhart LE. Mycoplasma genitalium infection and female reproductive tract disease: a meta-analysis. Clin Infect Dis 2015;61(3):418-26. [PubMed]
    • Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev 2011;24(3):498-514. [PubMed]