Mycoplasma Genitalium (MG), first identified in the 1980s, is one of six mycoplasma species that inhabit the urogenital and reproductive tracts of males and females with equal prevalence. MG is classified as a simple self-replicating prokaryote belonging to the bacteria class known as mollicutes. Over the past decade, MG has emerged as a sexually transmitted infection (STI) to be reckoned with due to the increase in prevalence, complications, morbidity, diagnostic difficulties, and antibiotic resistance. The prevalence of MG is greater than gonorrhea in sexually active young adults in the United States. MG is commonly seen in adolescents and young adults. Of individuals diagnosed with MG, 50% of partners test positive. Significant risk factors for MG infections include African American race, younger age, non-Hispanic ethnicity, and female symptomatic status.
Studies have shown an association of MG to increased risk of urethritis, prostatitis, mucopurulent cervicitis, pelvic inflammatory disease, adverse pregnancy outcomes, infertility, and neonatal infection. A high co-infection rate exists between MG and other STIs including Chlamydia trachomatis, trichomonas vaginitis, and a co-factor in HIV transmission. Prior bacterial vaginosis infections were associated with a 3.5-fold increase in odds of incident MG. This strong association suggests that BV may enhance susceptibility to MG infection. Testing for M. genitalium in asymptomatic populations is not currently recommended; improved diagnosis and management of BV may be a useful approach to mitigating these risks. Studies have shown suboptimal eradication rates of MG, thus indicating the bacteria has the primary link to recurrent and persistent STIs. Shedding of MG in untreated individuals can persist longer than 8-12 weeks.
Symptomology ranges from complaints of dysuria, penile or vaginal discharge, vaginal itching, vulvar erythema, and dyspareunia to being asymptomatic. Risks associated with MG infections were found to be those with greater numbers of partners in the past three months and those who have been diagnosed with Chlamydia. Detection of MG is difficult due to the fact the organism lacks a cell wall and is a small genome which creates a poor and slow growth in culture medium. There is no reliable gold standard diagnostic tool available as a commercial culture or assay, nor do present guidelines recommend testing of asymptomatic individuals. MG is most accurately diagnosed by nucleic acid amplification tests, including polymerase chain reaction and transcription-mediated amplified tests. These currently are available for research purposes in a limited number of medical facilities and labs. However, microscopic evidence of infection can be detected by increased white blood cells and bacteria on slides from urethral, vaginal, endocervical, and urine secretions.
MG should be suspected and treated presumptively in cases of recurrent urogenital infections or STIs and if microscopic findings and examination support treatment. Treatment options include a single dose of azithromycin or a 5-day dosing schedule. However, up to 40% of MG infections are resistant to azithromycin. Moxifloxin is recommended in its place for 7-10 days. However, quinolone resistance is beginning to trend. Healthcare providers need to be aware of the existence, prevalence, recurrence, treatment, complications, and antibiotic resistance of MG.
Baum, S. (2011). Mycoplasma hominis and ureaplasma urealyticum infections. Journal of Clinical Microbiology, 42(4), 425-438.
Baum, S., Waites, K. & Robinson, D. (2016). Clinical microbiology (9th ed.). Washington, D.C.: Associated Medical Press.
Baum, S. (2010). Principles and practice of infectious diseases (7th ed.). Philadelphia, Pennsylvania: Churchill Livingstone.
Bhattacharya, A. (2018). Emerging pathogens and antibiotic resistance in STIs an urgent challenge. Medical Laboratory Observer. 50(2), 18-29.
Cunningham, S., Mandrekar, J., Rosenblatt, J., & Patel, R. (2013). Rapid PCR detection of mycoplasma hominis, ureaplasma urealyticum, and ureaplasma parvum. International Journal of Bacteriology, 20(13), 1-7.
Dabrazhynetskaya, A., Volokhov, D., David, S., Ikonomi, P., Brewer, A., Chang, A. & Chizhikov, V. (2011). Preparation of reference strains for validation and comparison of mycoplasma testing methods. Journal of Applied Microbiology, 112(2), 904-914. doi:10.1111/j.1365-2672.2011.05108x
Davies, N. (2015). Mycoplasma genitalium: The need for testing and emerging diagnostic options. Medical Laboratory Observer, 47(12), 8-12.
Getman, D., Jiang, A., O’Donnell, M., & Cohen, S. (2016). Mycoplasma genitalium: Prevalence, coinfection, and macrolide antibiotic resistance frequency in a multi-center clinical study cohort in the United States. Journal of Clinical Microbiology, 54(9), 2278-2283. Doi:10.1128/JCM.01053-16
Jones, L., Felblinger, D., & Cooper, L. (2009). Mycoplasma genitalium: More prevalent than you think. Nurse Practitioner, 34(8), 50-52. doi:10.1097/01.NPR.0000358664.73596.4c
Manhart, L.E., & Trent, M. (2017). Mycoplasma genitalium: A review of current issues and challenges. Contemporary Obstetrics & Gynecology, 62(7) 1-6.
Manhart, L.E. (2013). Mycoplasma genitalium: An emergent sexually transmitted disease? Journal of Infectious Disease Clinics, 27(4), 779-792. doi:10.1016/j.idc.2013.08.003
McGowin, C.L., & Totten, P.A. (2017). The unique microbiology and molecular pathogenesis of mycoplasma genitalium. Journal of Infectious Diseases, 2, 382-388. doi.org.spot.lib.auburn.edu/10.1093/infdis/jix172
McGowin, C. L., Rohde, E. E., & Redwine, G. (2014). Epidemiological and clinical rationale for screening and diagnosis of mycoplasma genitalium infections. Clinical Laboratory Sciences, 27(1), 47-52.
Mobley, V., Senna, A. & Hobbs, M. (2012). Mycoplasma genitalium infection in women and men attending a sexually transmitted infection clinic: Diagnostic specimen type, coinfections, and predictors. Sexually Transmitted Disease, 39(706), 47-54.
Nye, M.B., Harris, A.B., Pherson, A.J., & Cartwright, C.P. (2020). Prevalence of mycoplasma genitalium infection in women with bacterial vaginosis. BMC Women’s Health, 20(62), doi.org/10.1186/s12905-020-00926-6
Ona, S., Molina, R., & Diouf, K. (2016). Mycoplasma genitalium: An overlooked sexually transmitted pathogen in women. Infectious Diseases in Obstetrics & Gynecology, 16, doi.org/10.1155/2016/4513089.
Ronda, J. Gaydos, C. Perin, J., Tobacco, L. Coleman, J., & Trent,M. (2018). Does mycoplasma genitalium infection predict future sexually transmitted infections in female urban adolescents and young adults? Journal of Adolescent Health, 62, 82-85. doi:10.1016/j.jadohealth.2017.11.165
Seña, A., Lee, J., Schwebke, J., Philip, S., Wiesenfeld, W., Rompalo, A., Cook, R., & Hobbs, M.
(2018) A silent epidemic: The prevalence, incidence and persistence of mycoplasma genitalium among young, asymptomatic high-risk women in the United States. Clinical Infectious Diseases, 67(1), 73–79, doi.org/10.1093/cid/ciy025.
Tan, L. (2017). Clinical and diagnostic challenges of antimicrobial resistance in mycoplasma genitalium. Medical Laboratory Observer, 49(5), 8-14.
Tosh, A. K., Van derPol, B., Fortenberry, J.D., Williams, J.A., Katz, B.P., Batteiger, B.E., & Orr, P. (2006). Mycoplasma genitalium among adolescent women and their partners. Journal of Adolescent Health, 40, 412-417. doi:10.1016/j.jadohealth.2006.12.00595
Wiesenfeld, H.C. & Manhart, L.E. (2017). Mycoplasma Genitalium in women: Current knowledge and research priorities for this recently emerged pathogen. Journal of Infectious Diseases, 2(216), 389-395. doi:10.1093/infdis/jix198
Mycoplasma Genitalium: An STI Issue More Prevalent Than We Know
Robin Gosdin Farrell, DNP, CRNP
Auburn University
rgf0001@auburn.edu
Mycoplasma Genitalium (MG), first identified in the 1980s, is one of six mycoplasma species that inhabit the urogenital and reproductive tracts of males and females with equal prevalence. MG is classified as a simple self-replicating prokaryote belonging to the bacteria class known as mollicutes. Over the past decade, MG has emerged as a sexually transmitted infection (STI) to be reckoned with due to the increase in prevalence, complications, morbidity, diagnostic difficulties, and antibiotic resistance. The prevalence of MG is greater than gonorrhea in sexually active young adults in the United States. MG is commonly seen in adolescents and young adults. Of individuals diagnosed with MG, 50% of partners test positive. Significant risk factors for MG infections include African American race, younger age, non-Hispanic ethnicity, and female symptomatic status.
Studies have shown an association of MG to increased risk of urethritis, prostatitis, mucopurulent cervicitis, pelvic inflammatory disease, adverse pregnancy outcomes, infertility, and neonatal infection. A high co-infection rate exists between MG and other STIs including Chlamydia trachomatis, trichomonas vaginitis, and a co-factor in HIV transmission. Prior bacterial vaginosis infections were associated with a 3.5-fold increase in odds of incident MG. This strong association suggests that BV may enhance susceptibility to MG infection. Testing for M. genitalium in asymptomatic populations is not currently recommended; improved diagnosis and management of BV may be a useful approach to mitigating these risks. Studies have shown suboptimal eradication rates of MG, thus indicating the bacteria has the primary link to recurrent and persistent STIs. Shedding of MG in untreated individuals can persist longer than 8-12 weeks.
Symptomology ranges from complaints of dysuria, penile or vaginal discharge, vaginal itching, vulvar erythema, and dyspareunia to being asymptomatic. Risks associated with MG infections were found to be those with greater numbers of partners in the past three months and those who have been diagnosed with Chlamydia. Detection of MG is difficult due to the fact the organism lacks a cell wall and is a small genome which creates a poor and slow growth in culture medium. There is no reliable gold standard diagnostic tool available as a commercial culture or assay, nor do present guidelines recommend testing of asymptomatic individuals. MG is most accurately diagnosed by nucleic acid amplification tests, including polymerase chain reaction and transcription-mediated amplified tests. These currently are available for research purposes in a limited number of medical facilities and labs. However, microscopic evidence of infection can be detected by increased white blood cells and bacteria on slides from urethral, vaginal, endocervical, and urine secretions.
MG should be suspected and treated presumptively in cases of recurrent urogenital infections or STIs and if microscopic findings and examination support treatment. Treatment options include a single dose of azithromycin or a 5-day dosing schedule. However, up to 40% of MG infections are resistant to azithromycin. Moxifloxin is recommended in its place for 7-10 days. However, quinolone resistance is beginning to trend. Healthcare providers need to be aware of the existence, prevalence, recurrence, treatment, complications, and antibiotic resistance of MG.
References
Association of Public Health Laboratories. (2019). Mycoplasma genitalium: An emerging issue in the world of sexually transmitted infections. https://www.ncsddc.org/wp-content/uploads/2019/04/ID-2019Feb-M-genitalium-fact-sheet.pdf
Baum, S. (2011). Mycoplasma hominis and ureaplasma urealyticum infections. Journal of Clinical Microbiology, 42(4), 425-438.
Baum, S., Waites, K. & Robinson, D. (2016). Clinical microbiology (9th ed.). Washington, D.C.: Associated Medical Press.
Baum, S. (2010). Principles and practice of infectious diseases (7th ed.). Philadelphia, Pennsylvania: Churchill Livingstone.
Bhattacharya, A. (2018). Emerging pathogens and antibiotic resistance in STIs an urgent challenge. Medical Laboratory Observer. 50(2), 18-29.
Cunningham, S., Mandrekar, J., Rosenblatt, J., & Patel, R. (2013). Rapid PCR detection of mycoplasma hominis, ureaplasma urealyticum, and ureaplasma parvum. International Journal of Bacteriology, 20(13), 1-7.
Dabrazhynetskaya, A., Volokhov, D., David, S., Ikonomi, P., Brewer, A., Chang, A. & Chizhikov, V. (2011). Preparation of reference strains for validation and comparison of mycoplasma testing methods. Journal of Applied Microbiology, 112(2), 904-914. doi:10.1111/j.1365-2672.2011.05108x
Davies, N. (2015). Mycoplasma genitalium: The need for testing and emerging diagnostic options. Medical Laboratory Observer, 47(12), 8-12.
Getman, D., Jiang, A., O’Donnell, M., & Cohen, S. (2016). Mycoplasma genitalium: Prevalence, coinfection, and macrolide antibiotic resistance frequency in a multi-center clinical study cohort in the United States. Journal of Clinical Microbiology, 54(9), 2278-2283. Doi:10.1128/JCM.01053-16
Heavey, E. (2017). Mycoplasma genitalium. Nursing, 47(7) 61-62. doi:10.1097/01.NURSE.0000520524.30192.07
Jones, L., Felblinger, D., & Cooper, L. (2009). Mycoplasma genitalium: More prevalent than you think. Nurse Practitioner, 34(8), 50-52. doi:10.1097/01.NPR.0000358664.73596.4c
Kent, B. Emerging sexually transmitted diseases. Clinical Laboratory Science, 30(2), 124-130.
Manhart, L.E., & Trent, M. (2017). Mycoplasma genitalium: A review of current issues and challenges. Contemporary Obstetrics & Gynecology, 62(7) 1-6.
Manhart, L.E. (2013). Mycoplasma genitalium: An emergent sexually transmitted disease? Journal of Infectious Disease Clinics, 27(4), 779-792. doi:10.1016/j.idc.2013.08.003
McGowin, C.L., & Totten, P.A. (2017). The unique microbiology and molecular pathogenesis of mycoplasma genitalium. Journal of Infectious Diseases, 2, 382-388. doi.org.spot.lib.auburn.edu/10.1093/infdis/jix172
McGowin, C. L., Rohde, E. E., & Redwine, G. (2014). Epidemiological and clinical rationale for screening and diagnosis of mycoplasma genitalium infections. Clinical Laboratory Sciences, 27(1), 47-52.
Mobley, V., Senna, A. & Hobbs, M. (2012). Mycoplasma genitalium infection in women and men attending a sexually transmitted infection clinic: Diagnostic specimen type, coinfections, and predictors. Sexually Transmitted Disease, 39(706), 47-54.
Nye, M.B., Harris, A.B., Pherson, A.J., & Cartwright, C.P. (2020). Prevalence of mycoplasma genitalium infection in women with bacterial vaginosis. BMC Women’s Health, 20(62), doi.org/10.1186/s12905-020-00926-6
Ona, S., Molina, R., & Diouf, K. (2016). Mycoplasma genitalium: An overlooked sexually transmitted pathogen in women. Infectious Diseases in Obstetrics & Gynecology, 16, doi.org/10.1155/2016/4513089.
Ronda, J. Gaydos, C. Perin, J., Tobacco, L. Coleman, J., & Trent,M. (2018). Does mycoplasma genitalium infection predict future sexually transmitted infections in female urban adolescents and young adults? Journal of Adolescent Health, 62, 82-85. doi:10.1016/j.jadohealth.2017.11.165
Seña, A., Lee, J., Schwebke, J., Philip, S., Wiesenfeld, W., Rompalo, A., Cook, R., & Hobbs, M.
(2018) A silent epidemic: The prevalence, incidence and persistence of mycoplasma genitalium among young, asymptomatic high-risk women in the United States. Clinical Infectious Diseases, 67(1), 73–79, doi.org/10.1093/cid/ciy025.
Tan, L. (2017). Clinical and diagnostic challenges of antimicrobial resistance in mycoplasma genitalium. Medical Laboratory Observer, 49(5), 8-14.
Tosh, A. K., Van derPol, B., Fortenberry, J.D., Williams, J.A., Katz, B.P., Batteiger, B.E., & Orr, P. (2006). Mycoplasma genitalium among adolescent women and their partners. Journal of Adolescent Health, 40, 412-417. doi:10.1016/j.jadohealth.2006.12.00595
Wiesenfeld, H.C. & Manhart, L.E. (2017). Mycoplasma Genitalium in women: Current knowledge and research priorities for this recently emerged pathogen. Journal of Infectious Diseases, 2(216), 389-395. doi:10.1093/infdis/jix198
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