Mycoplasma Genitalium

Have you heard of Mycoplasma Genitalium infection? This is a name that is less heard of by most of us. This article strives to increase awareness of mycoplasma genitalium infection and highlights the importance of screening and treating this condition.

Background of Mycoplasma Genitalium

Mycoplasma genitalium, aka Mgen, is a type of sexually transmitted disease (STD). It first appeared in the 1980s when it was found in the urinary tract opening (urethral) sample of 2 male patients in London. Since then, it has been known to be associated with urethritis (infection of the urinary tract opening) in men and many gynaecological complications, including pelvic inflammatory disease in women.

Why should I screen for Mycoplasma Genitalium?

1. An unheard/less heard of medical condition, Mycoplasma Genitalium does not equate to the non-existence of this medical condition

Mycoplasma Genitalium remains a bacteria that is elusively thriving in the community as it is less heard of and less screened for. Over the years, increasing demographic evidence has shown that the infection is rising in society.

Based on CDC data, Mycoplasma genitalium infection is associated with 15-20% of non-gonococcal urethritis cases in men. Mycoplasma genitalium is also associated with cervicitis (10-30%), pelvic inflammatory disease (4-22%), and infertility issues in women. The risks of gynaecological complications increase twice in a female with untreated Mycoplasma genitalium. Mycoplasma genitalium is also associated with rectal infection, where it is slightly more common in MSM (men-sex-men), contributing up to 26% of the cases and affecting 3% of rectal infections in women.

2. Untreated Mycoplasma Genitalium increases the risk of other STDs, including HIV and HPV infections

During infection, the Mycoplasma Genitalium bacteria attach and invade the surface of the affected skin cells, weakening the skin barrier integrity. This increases the risk of transmission, acquisition, and reproduction of other STD infections, such as HIV and/or even HPV, and allows the affected person to shred the viruses easily through the skin surface.

A person with untreated sexually transmitted disease is more predisposed to acquiring other STDs, including HIV. In Mycoplasma Genitalium infection, as the infective symptoms can be vague and one may not routinely screen for the infection, this leads to further risk of contracting other STDs during sexual contact.

3. Signs and symptoms of Mycoplasma Genitalium can mimic Chlamydia Trachomatis infection

Patients or even physicians can sometimes be confused about symptoms of Mycoplasma Genitalium as there are similarities of symptoms with common bacterial STDs such as chlamydia or gonorrheal infection.

• Patients with Mycoplasma Genitalium can be asymptomatic.
• When having symptoms, both affected men and women can present with urethritis symptoms such as abnormal urinary discharge, painful and burning sensation during urination, and itching over the urethral (urinary tract opening region).
• In women, one may experience vaginal symptoms such as vaginal itch, abnormal discharge, lower pelvic pain, bleeding after sex, and abnormal bleeding in between periods.
• Rectal symptoms associated with mycoplasma genitalium tend to be minimal (or even asymptomatic). However, an infected patient can present with anal discharge, anal pain or itch, or a change of bowel habits.

If you have abnormal genito-urinary symptoms, do reach out to your trusted physician for further sexual health screening.

4. Mycoplasma Genitalium infection can lead to long-term complications in women

• Untreated Mycoplasma Genitalium infection in females can be associated with pelvic inflammatory disease. Over time, together with chronic inflammation and infection, one can develop chronic pelvic pain due to underlying endometritis (uterus infection), salpingitis (fallopian tube infection), and pelvic scarring.
• Chronic Mycoplasma Genitalium infection also can lead to chronic inflammation changes of the cervix, a condition known as cervicitis.
• In terms of pregnancy, the presence of Mycoplasma Genitalium infection increases perinatal morbidity and mortality. Mycoplasma Genitalium infection is associated with infertility, ectopic pregnancy, spontaneous abortion, preterm labour and low birth rate.

You are encouraged to get screened and treated early if you are at risk of acquiring Mycoplasma Genitalium. You can speak with your trusted doctor to understand more about the screening and treatment options.

5. Mycoplasma Genitalium infection can lead to long-term complications in men

Mycoplasma Genitalium infection plays a role in non-gonococcal urethritis (15-20%). Chronic inflammation from Mycoplasma Genitalium infection may also contribute to male infertility issues due to underlying epididymitis and prostatitis.

As discussed, rectal infection and pharyngeal symptoms with Mycoplasma Genitalium can be seen more frequently in MSM (men-sex-men). The symptoms presented can be vague, or the patient may not even have any concerning symptoms at all, thus giving rise to further opportunities for the infection to spread insidiously and rampantly to other sex partners.

6. Rising antibiotic resistance against the treatment of Mycoplasma Genitalium

The concern with treatment failure of Mycoplasma Genitalium infection is due to the rise of antibiotic resistance. Azithromycin, in particular, is a type of macrolide antibiotic frequently used in genitourinary infections. However, there are increasing reports of resistance against azithromycin leading to treatment failure. Currently, the CDC recommends combination antibiotics for the treatment of Mycoplasma Genitalium.

Given the rising antibiotic resistance, it is prudent for both patients and physicians to consider screening tests before offering treatment to avoid unnecessary repeated blind antibiotics treatment. Post-treatment clearance tests may be provided to ensure the infection has been eradicated successfully.

7. Your immune system will not clear off Mycoplasma Genitalium itself

Unfortunately, It is a myth that one will eventually clear off STD infections such as Mycoplasma Genitalium over time with good immunity. While an excellent immune system allows a person a better response to overall treatment and a quicker recuperating period, you will need the right antibiotics and the right dosage of antibiotics to ward off the infection. STDs will not resolve on their own.

8. Mycoplasma Genitalium is different from other forms of mycoplasma infection

Commonly, one may wonder whether Mycoplasma Genitalium is similar to Mycoplasma Pneumoniae –  a type of respiratory tract infection that can be associated with pneumonia requiring hospitalisation. The answer is no; despite the name, they are different types of bacteria. Mycoplasma Genitalium is transmitted sexually, while Mycoplasma Pneumonia can be transmitted through contact with respiratory droplets.

9. Sexual practices may predispose to mycoplasma genitalium or other STDs

Sexual practices such as multiple sexual partners, casual sex, and becoming sexually active at a young age predispose a person to STDs, including Mycoplasma Genitalium infection. It is noted that the risk of contracting Mycoplasma Genitalium increases with the additional number of sexual partners.

In a local population study conducted across over 2000 sexually experienced Singaporean men (60.1%),  16% were involved in casual sex and 78.4% were involved in commercial sex services. The studies may not even reflect the actual demographic pattern as the results were likely underreported due to the local cultural and social barrier to disclosure of one’s sexual history.

To screen or not to screen…

In a realistic world, while the cost of screening for Mycoplasma Genitalium may take a toll on the healthcare expenditure of a patient and the healthcare system, the long-term complications of untreated Mycoplasma Genitalium and treatment costs are factors worth considering.

It is good practice to discuss with your trusted doctor your sexual history and risk of exposure so that your doctor can guide you with a suitable STD screening plan in the context of your individual risks and social background.

References

1. Ona S, Molina RL, Diouf K. Mycoplasma genitalium: An Overlooked Sexually Transmitted Pathogen in Women? Infect Dis Obstet Gynecol. 2016;2016:4513089. doi: 10.1155/2016/4513089.
2. Manhart LE, Broad JM, Golden MR. Mycoplasma genitalium: should we treat and how? Clin Infect Dis. 2011 Dec;53 Suppl 3(Suppl 3):S129-42. doi: 10.1093/cid/cir702.
3. Sethi S, Zaman K, Jain N. Mycoplasma genitalium infections: current treatment options and resistance issues. Infect Drug Resist. 2017 Sep 1;10:283-292. doi: 10.2147/IDR.S105469.
4. Heng BH, Lee HP, Kok LP, Ong YW, Ho ML. A survey of sexual behaviour of Singaporeans. Ann Acad Med Singap. 1992 Nov;21(6):723-9.
5. https://www.cdc.gov/std/treatment-guidelines/mycoplasmagenitalium.htm