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, moxifloxacin400 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]