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Mycoplasma Genitalium

Overview

Mycoplasma genitalium, known as Mgen or also referred to as M. genitalium, is a bacterial infection transmitted sexually. It is a tiny bacterium infecting the urogenital tract, womb, fallopian tubes, and urethra in women while affecting urethra and epididymis in men. The symptoms of Mycoplasma genitalium resemble that of Chlamydia infection, but a different bacterium causes it. Many cases in the past have been misdiagnosed and treated as chlamydia, which led to further research on Mgen about antibiotics and developing resistance as the treatment for chlamydia does not completely eradicate mycoplasma genitalium.

 

It is possible to have both infections simultaneously. Chlamydia is more common and easily transmitted than Mgen. It is often asymptomatic, but it can result in serious health issues if not treated accordingly on time. Mgen can become a 'superbug,’ which means a bacterium resistant to most antibiotic treatments.

Causes

Mycoplasma genitalium is a small bacteria that causes this illness.  It can be transmitted if a person has sex with the infected person.  It can attack the mucus membranes of the urethra, cervix, throat, or anus. It is transmitted through vaginal, anal, and oral sex. Mycoplasma bacterium is very common in young people and people who have unprotected sex.

Epidemiology

M genitalium infection is one of the causes of STIs globally; it is prevalent in 0.4% of people in the USA, 4.5 % in the Netherlands, and around 6.3% in Sweden. Mycoplasma genitalium infects 1 to 2 in every 100 adults aged 16-44 years old in the United Kingdom in sexually active people. Some researchers think Mgen may infect around 2% of Europeans and 3% of the world's population. 

 

The infection rate is greatest in people who have multiple sexual partners or those who do not practice safe sex, and this applies to all cases of STIs. It is also common in people who smoke and those of non-white ethnicity. Globally, one of every 100 adults is thought to have MG, while more than three of every 100 homosexual or bisexual men get infected, according to a study on Sexually Transmitted Infections.

Risk Factors

1.       Pregnancy

2.       Mycoplasma genitalium has a strong link to preterm birth and miscarriages. Mycoplasma genitalium can be passed to the baby at the time of vaginal delivery. It is unclear whether Mgen can pass to the baby in the womb (uterus), and it is also not clear whether this would harm the baby. If Mycoplasma genitalium is detected during pregnancy, inform your midwife and obstetrician. It is also very important that you consult with your healthcare provider who is treating your Mgen if you are pregnant, as some antibiotics used for Mgen are not safe for use in pregnancy.

3.       Multiple sexual partners

4.       Pelvic inflammatory disease

5.       Existing non-gonococcal urethritis

6.       Bacterial vaginosis

7.       Smokers

 

8.       Homosexuality

Signs And Symptoms

Signs and symptoms in males include:

 

·         Urethritis (inflammation and swelling of the tube that carries urine from the bladder to the outside).

·         Pain on passing urine.

·         Pain on ejaculation.

·         Cloudy or watery discharge from the penis.

·         Inflammation of the rectum (proctitis).

·         Inflammation of the foreskin and penis.

·         Penile discharge

·         Stinging or burning on passing urine

 

Signs and symptoms in females include:

 

·         Pain in the pelvis

·         Pain during sexual intercourse

·         Abnormal vaginal discharge

·         Urethritis is an infection of the urethra causing pain in urination and soreness in the external genitalia.

·         Increased or altered vaginal discharge.

·         Intermenstrual bleeding (Bleeding between periods)

·         Cervicitis is the inflammation of the cervix resulting in pain during intercourse and discharge or bleeding after intercourse.

 

·         Lower abdominal (tummy) pain.

Diagnosis

Diagnosis of Mycoplasma genitalium is critical. Initially, it is crucial to isolate MG as the cause if urethritis or cervicitis is recurrent and to check the response to antibiotic therapy. Isolating MG can aid in selecting the appropriate antibiotic and exclude those more closely related to resistance (such as macrolides like azithromycin and fluoroquinolones like ciprofloxacin).

Nucleic acid amplification test (NAAT) is the gold method of diagnosis. It can be used to test urine, endometrial biopsies, urethral, vaginal, and cervical swabs. The NAAT tests for the genetic material of Mycoplasma genitalia are not only accurate but fast, usually returning a result in 24 to 48 hours. The NAAT is also the gold standard method of testing for chlamydia. The NAAT avails a technology called polymerase chain reaction (PCR), in which the genetic material of the bacterium is amplified to facilitate accurate detection.

 

The NAAT is a very challenging test until and unless performed correctly, the test may come up with a false-negative result. To minimize this, the provider should ideally take a urine sample and a swab of the urethra, vagina, or cervix. This increases the possibility of accurate diagnosis and helps overcome derangements in sample collection and results.

Differential Diagnosis

If any borderline test result is returned, the healthcare provider may perform a repeat NAAT or increase the scope of the investigation. When chlamydia and gonorrhea have been ruled out, then other differentials may include:

·         Bacterial vaginosis

·         E. coli cystitis

·         Herpes simplex virus (HSV) infection 

·         Prostatitis

·         Salpingitis (inflammation of the fallopian tubes)

·         Syphilis

·         Trichomonas vaginalis

·         Ureaplasma urealyticum is a bacterial infection of the genital tract.

 

·         Urethral abscess, urethritis 

 

Treatment

Mycoplasma genitalium treatment is diverse, as the bacteria are rapidly becoming resistant to the usual routine treatments. The primary treatment used to be a single dose of an antibiotic, azithromycin. However, longer courses of treatment are needed nowadays due to the development of resistance to these antibiotics. New medicines like pristinamycin, solithromycin, and sitafloxacin are being tried. If patients don't complete the course of antibiotics, Mgen is not entirely eradicated, leading to further drug resistance.

Current sexual partners must be given the same treatment regime of antibiotics as that given to the patient. The treatment regime may include Doxycycline 100 mg two times a day for seven days; or Azithromycin 1 g is given as a single dose, then 500 mg is given daily for two more days; or Moxifloxacin 400 mg daily for 10 days. This is currently used for cases that are resistant to azithromycin. Resistance to moxifloxacin is becoming problematic in Asia. If these are not effective, alternative treatments are available with Doxycycline, Pristinamycin, and Minocycline.  It is suggested that a repeat test should be done three weeks after finishing treatment to confirm the infection has completely gone. One of the main causes of medication resistance is the incomplete treatment of infections. If infections are not treated completely, a few bacteria stay which resist the antibiotic; these bacteria develop an immune mechanism which is then passed on as they divide and grow.

Prognosis

If Mycoplasma genitalium is treated with antibiotics properly with a complete regimen, then it is unlikely to cause any long-term health issues. Mycoplasma genitalium causes tubal damage in patients who develop Pelvic inflammatory disease (PID). This could result in irreversible tubal damage, affecting fertility at worst. It is not clear whether Mycoplasma genitalium can cause infertility in men who develop epididymal-orchitis - this is possible, but research is ongoing.

 

Suppose reactive arthritis develops as a result of Mycoplasma genitalium. In that case, it is likely that, as for chlamydia, treatment of the Mycoplasma genitalium will treat arthritis. Still, it typically takes a few months to settle down and resolve the issue altogether.

Prevention

You can prevent yourself from getting infected with M.genitalium by;

·         Adapting safe sex (using condoms)

·         Having limited sexual partners

·         Regular screening for STIs

·         Not having sex with someone suffering from STIs

 

·         Avoid sex until completing your full course of antibiotics.

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