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 Chlamydial Urethritis and Cervicitis 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.
Aetiology and clinical picture
Mycoplasma genitalium is the smallest known bacteria.
Clinical picture resembles that of Chlamydia infection.
Asymptomatic infections are common.
Mycoplasma causes urethritis in men, cervicitis in women, and it may also cause pelvic inflammatory disease Pelvic Inflammatory Disease (PID).
If there is suspicion of a strain resistant to azithromycin, antimicrobial sensitivity testing may be additionally performed.
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.
A follow-up sample 4 weeks after the treatment is recommended 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
Taylor-Robinson D, Jensen JS. Mycoplasma genitalium: from Chrysalis to multicolored butterfly. Clin Microbiol Rev 2011;24(3):498-514. [PubMed]
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]
Jensen JS, Cusini M, Gomberg M, et al. 2021 European guideline on the management of Mycoplasma genitalium infections (in press). The International Union against Sexually Transmitted Infections (IUSTI) http://iusti.org/treatment-guidelines/.